Healthcare Provider Details

I. General information

NPI: 1619804572
Provider Name (Legal Business Name): ISABEL AMIA MURDOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 N SILVER FOX RD
IDAHO FALLS ID
83401-6756
US

IV. Provider business mailing address

5880 N SILVER FOX RD
IDAHO FALLS ID
83401-6756
US

V. Phone/Fax

Practice location:
  • Phone: 208-973-5618
  • Fax:
Mailing address:
  • Phone: 208-973-5618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: