Healthcare Provider Details

I. General information

NPI: 1477589216
Provider Name (Legal Business Name): JUDI BEAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIANA BEAN N.P

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E. WINDING CREEK DRIVE
EAGLE ID
83616
US

IV. Provider business mailing address

1502 E REGATTA ST
BOISE ID
83706-6323
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-8887
  • Fax: 208-938-8897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP93A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP30001704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: