Healthcare Provider Details

I. General information

NPI: 1033755079
Provider Name (Legal Business Name): MARIE LYNNE ESPLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE LYNNE PERRAULT NP

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N PLYMOUTH AVE
NEW PLYMOUTH ID
83655-5525
US

IV. Provider business mailing address

1441 NE 10TH AVE
PAYETTE ID
83661-5420
US

V. Phone/Fax

Practice location:
  • Phone: 208-278-3335
  • Fax: 208-278-3337
Mailing address:
  • Phone: 208-642-9376
  • Fax: 208-642-9598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61928
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: