Healthcare Provider Details

I. General information

NPI: 1437661345
Provider Name (Legal Business Name): BENJAMIN PRINZING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 E PLAZA DR STE 110
EAGLE ID
83616-6567
US

IV. Provider business mailing address

3725 S COLDSTREAM AVE
BOISE ID
83709-4821
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-5680
  • Fax:
Mailing address:
  • Phone: 208-859-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57136
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: