Healthcare Provider Details

I. General information

NPI: 1235603630
Provider Name (Legal Business Name): NATHAN SCOTT WEST HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 N MERIDIAN RD
MERIDIAN ID
83646-6065
US

IV. Provider business mailing address

3330 N MERIDIAN RD
MERIDIAN ID
83646-6065
US

V. Phone/Fax

Practice location:
  • Phone: 208-519-1805
  • Fax:
Mailing address:
  • Phone: 208-519-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2899
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: