Healthcare Provider Details

I. General information

NPI: 1164247094
Provider Name (Legal Business Name): EVA HUFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2024
Last Update Date: 11/16/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 S TOPAZ WAY UNIT 100
MERIDIAN ID
83642-4477
US

IV. Provider business mailing address

11853 W SILVER CITY CT
BOISE ID
83713-0818
US

V. Phone/Fax

Practice location:
  • Phone: 208-417-7971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: