Healthcare Provider Details

I. General information

NPI: 1154033637
Provider Name (Legal Business Name): SHAINA LEEANN LONAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 5TH ST
WILDER ID
83676-5540
US

IV. Provider business mailing address

911 7TH ST S
NAMPA ID
83651-4121
US

V. Phone/Fax

Practice location:
  • Phone: 208-482-7430
  • Fax:
Mailing address:
  • Phone: 509-288-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53665
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: