Healthcare Provider Details

I. General information

NPI: 1285896274
Provider Name (Legal Business Name): PATSY RUTH BOATRIGHT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E 25TH ST
IDAHO FALLS ID
83404-7549
US

IV. Provider business mailing address

PO BOX 50934
IDAHO FALLS ID
83405-0934
US

V. Phone/Fax

Practice location:
  • Phone: 208-542-1026
  • Fax: 208-557-7494
Mailing address:
  • Phone: 208-206-7148
  • Fax: 280-523-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberN-28353
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: