Healthcare Provider Details

I. General information

NPI: 1629508148
Provider Name (Legal Business Name): CECILIA ROSALIE MOTSCHENBACHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CECILIA MITCHELL

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD
MERIDIAN ID
83642-6351
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-706-5651
  • Fax: 208-706-5344
Mailing address:
  • Phone: 208-381-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74912
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number891787
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134200
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: