Healthcare Provider Details

I. General information

NPI: 1043290414
Provider Name (Legal Business Name): BEVERLY A SCHIFFLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S PLYMOUTH AVE
NEW PLYMOUTH ID
83655-5523
US

IV. Provider business mailing address

4074 S IRIONDO WAY
BOISE ID
83706-5784
US

V. Phone/Fax

Practice location:
  • Phone: 208-278-3406
  • Fax: 208-278-3418
Mailing address:
  • Phone: 208-426-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-619A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: