Healthcare Provider Details

I. General information

NPI: 1356680862
Provider Name (Legal Business Name): FAWNA SUNSHINE HUFFMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 S MAIN ST STE 320
MOSCOW ID
83843-3574
US

IV. Provider business mailing address

PO BOX 8007
MOSCOW ID
83843-0507
US

V. Phone/Fax

Practice location:
  • Phone: 208-883-1846
  • Fax: 208-892-1116
Mailing address:
  • Phone: 208-882-4511
  • Fax: 208-883-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1245A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: