Healthcare Provider Details

I. General information

NPI: 1780115048
Provider Name (Legal Business Name): CASIE SPEARING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 POLE LINE RD W #112
TWIN FALLS ID
83301-5814
US

IV. Provider business mailing address

312 7TH AVE N
TWIN FALLS ID
83301-5951
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-8200
  • Fax: 208-933-4921
Mailing address:
  • Phone: 208-212-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number39137
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: