Healthcare Provider Details

I. General information

NPI: 1932787223
Provider Name (Legal Business Name): DAVID MICHAEL UNDERHILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 US-2
PRIEST RIVER ID
83856
US

IV. Provider business mailing address

771 PLUMBAGO POINT RD NO. 45
COOLIN ID
83821
US

V. Phone/Fax

Practice location:
  • Phone: 208-448-2321
  • Fax:
Mailing address:
  • Phone: 571-276-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2681213
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: