Healthcare Provider Details

I. General information

NPI: 1245164631
Provider Name (Legal Business Name): SHEYANN MARIE BAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

244 W CENTER ST
FIRTH ID
83236-4702
US

IV. Provider business mailing address

244 W CENTER ST
FIRTH ID
83236-4702
US

V. Phone/Fax

Practice location:
  • Phone: 208-716-5116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number36870
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: