Healthcare Provider Details

I. General information

NPI: 1912511213
Provider Name (Legal Business Name): IRENE M OHLS CNA, PHLEBOTOMIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W LOGAN ST
CALDWELL ID
83605-1710
US

IV. Provider business mailing address

4805 AUSTRIAN SETTLEMENT RD
HOMEDALE ID
83628-3611
US

V. Phone/Fax

Practice location:
  • Phone: 208-994-9377
  • Fax:
Mailing address:
  • Phone: 208-994-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number00038610602
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: