Healthcare Provider Details

I. General information

NPI: 1184536070
Provider Name (Legal Business Name): SUMI RANA SHRESTHA SR. BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 E CROWNE POINTE DR
EAGLE ID
83616-5578
US

IV. Provider business mailing address

1126 E CROWNE POINTE DR
EAGLE ID
83616-5578
US

V. Phone/Fax

Practice location:
  • Phone: 208-672-0260
  • Fax: 208-321-7750
Mailing address:
  • Phone: 208-672-0260
  • Fax: 208-321-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: