Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
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

1769 GAGE AVE
TWIN FALLS ID
83301-0242
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7271
  • Fax:
Mailing address:
  • Phone: 208-316-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number63773
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: