Healthcare Provider Details

I. General information

NPI: 1558295667
Provider Name (Legal Business Name): EMILY WALGAMOTT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W 500 N
JEROME ID
83338-5032
US

IV. Provider business mailing address

207 W 500 N
JEROME ID
83338-5032
US

V. Phone/Fax

Practice location:
  • Phone: 208-539-0756
  • Fax:
Mailing address:
  • Phone: 208-539-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number142862
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: