Healthcare Provider Details

I. General information

NPI: 1164383865
Provider Name (Legal Business Name): SHAWNA LAFOLLETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 NW 16TH ST
FRUITLAND ID
83619-2202
US

IV. Provider business mailing address

2632 N WASHINGTON AVE
EMMETT ID
83617-9556
US

V. Phone/Fax

Practice location:
  • Phone: 208-453-9850
  • Fax:
Mailing address:
  • Phone: 208-412-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number31847
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: