Healthcare Provider Details

I. General information

NPI: 1932075397
Provider Name (Legal Business Name): ALTAN URBAEVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

IV. Provider business mailing address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

V. Phone/Fax

Practice location:
  • Phone: 208-919-2455
  • Fax:
Mailing address:
  • Phone: 208-899-9062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: