Healthcare Provider Details

I. General information

NPI: 1083578413
Provider Name (Legal Business Name): MRS. EMMA ANDREASEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA PIKE

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 POLE LINE RD W STE 2A
TWIN FALLS ID
83301-4270
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7271
  • Fax: 208-814-7290
Mailing address:
  • Phone: 208-381-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5281605
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: