Healthcare Provider Details

I. General information

NPI: 1245017375
Provider Name (Legal Business Name): MATTHEW MITCHELL DAY APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 03/30/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4511 ZEBE AVE
CHUBBUCK ID
83202-4707
US

IV. Provider business mailing address

4511 ZEBE AVE
CHUBBUCK ID
83202-4707
US

V. Phone/Fax

Practice location:
  • Phone: 208-904-4832
  • Fax:
Mailing address:
  • Phone: 208-904-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number61448
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number61448
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number61448
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: