Healthcare Provider Details

I. General information

NPI: 1750837548
Provider Name (Legal Business Name): JOHN-PAUL DENHAM ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 05/30/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3886 S SARTEANO AVE
MERIDIAN ID
83642
US

IV. Provider business mailing address

9169 W STATE ST # 3411
GARDEN CITY ID
83714-1733
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-3501
  • Fax: 909-314-2467
Mailing address:
  • Phone: 208-918-3501
  • Fax: 909-314-2467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60093231
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60687161
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60687161
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: