Healthcare Provider Details

I. General information

NPI: 1386560191
Provider Name (Legal Business Name): SHIREE GLORIA MARSH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POLE LINE RD W
TWIN FALLS ID
83301-5799
US

IV. Provider business mailing address

1620 EASTPOINTE DR
POCATELLO ID
83201-5160
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-1000
  • Fax:
Mailing address:
  • Phone: 208-814-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number54195
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: