Healthcare Provider Details

I. General information

NPI: 1023947736
Provider Name (Legal Business Name): BRIANA ADAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 SHOUP AVE STE 205
IDAHO FALLS ID
83402-3658
US

IV. Provider business mailing address

555 W MIKAN DR APT 8312
REXBURG ID
83440-8038
US

V. Phone/Fax

Practice location:
  • Phone: 208-497-2781
  • Fax:
Mailing address:
  • Phone: 253-330-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: