Healthcare Provider Details

I. General information

NPI: 1871056523
Provider Name (Legal Business Name): HILLARY RUHL DUENAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 05/22/2023
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 SHOUP AVE W STE B
TWIN FALLS ID
83301-5027
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM-16922
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: