Healthcare Provider Details

I. General information

NPI: 1194158246
Provider Name (Legal Business Name): TONI R MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 04/07/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W NEZ PERCE
JEROME ID
83338-5077
US

IV. Provider business mailing address

794 EASTLAND DR
TWIN FALLS ID
83301-6856
US

V. Phone/Fax

Practice location:
  • Phone: 208-324-3471
  • Fax: 208-324-9191
Mailing address:
  • Phone: 208-737-6718
  • Fax: 208-436-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1301A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: