Healthcare Provider Details

I. General information

NPI: 1275212730
Provider Name (Legal Business Name): FERDINAND NYABENDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 N CENTREPOINT WAY UNIT M101
MERIDIAN ID
83646-3726
US

IV. Provider business mailing address

3423 N CENTREPOINT WAY UNIT T101
MERIDIAN ID
83646-6735
US

V. Phone/Fax

Practice location:
  • Phone: 208-936-0670
  • Fax:
Mailing address:
  • Phone: 208-936-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: