Healthcare Provider Details

I. General information

NPI: 1043192578
Provider Name (Legal Business Name): HANNAH DYER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N CRESTMONT DR STE A
MERIDIAN ID
83642-2177
US

IV. Provider business mailing address

1550 N CRESTMONT DR STE A
MERIDIAN ID
83642-2177
US

V. Phone/Fax

Practice location:
  • Phone: 208-288-4200
  • Fax: 208-288-4279
Mailing address:
  • Phone: 208-288-4200
  • Fax: 208-288-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8971766
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: