Healthcare Provider Details

I. General information

NPI: 1356422562
Provider Name (Legal Business Name): LINDA K DEWITT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 17TH ST STE B
LEWISTON ID
83501-6311
US

IV. Provider business mailing address

2517 17TH ST STE B
LEWISTON ID
83501-6311
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-4373
  • Fax: 208-743-3369
Mailing address:
  • Phone: 208-743-4373
  • Fax: 208-743-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007060
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: