Healthcare Provider Details

I. General information

NPI: 1447131917
Provider Name (Legal Business Name): NINA TITCHENAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 CHAMBERS WAY
CALDWELL ID
83607-5518
US

IV. Provider business mailing address

16835 CHAMBERS WAY
CALDWELL ID
83607-5518
US

V. Phone/Fax

Practice location:
  • Phone: 208-971-5035
  • Fax:
Mailing address:
  • Phone: 208-971-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2571997
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2571997
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2571997
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: