Healthcare Provider Details

I. General information

NPI: 1548220874
Provider Name (Legal Business Name): FAITH YOUNG PETERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN
MARSING ID
83639
US

IV. Provider business mailing address

PO BOX 9 211 16TH AVENUE NORTH
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-896-4159
  • Fax: 208-896-4917
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-467-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP296A
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: