Healthcare Provider Details

I. General information

NPI: 1407214497
Provider Name (Legal Business Name): AMY DANCER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY WOODS N.P.

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2347 E GALA ST
MERIDIAN ID
83642-4881
US

IV. Provider business mailing address

2347 E GALA ST
MERIDIAN ID
83642-4881
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-3676
  • Fax:
Mailing address:
  • Phone: 208-323-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-31964
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1707A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: