Healthcare Provider Details

I. General information

NPI: 1720998768
Provider Name (Legal Business Name): GEORGETTE AFYA INGABIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16641 CHAMBERS WAY
CALDWELL ID
83607-5872
US

IV. Provider business mailing address

16641 CHAMBERS WAY
CALDWELL ID
83607-5872
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-3022
  • Fax: 701-651-3022
Mailing address:
  • Phone: 701-651-3022
  • Fax: 701-651-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberAD014653V
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: