Healthcare Provider Details

I. General information

NPI: 1427147511
Provider Name (Legal Business Name): SUZANNE NEBEKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MAIN ST
SALMON ID
83467-0000
US

IV. Provider business mailing address

203 S DAISY ST
SALMON ID
83467-0000
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-6212
  • Fax: 208-756-6336
Mailing address:
  • Phone: 208-756-5600
  • Fax: 208-756-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-468A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: