=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003366014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK ANDREW RINELLA IV IV NRP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2016
-----------------------------------------------------
Last Update Date | 10/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6658 COMANCHE ST
-----------------------------------------------------
City | BONNERS FERRY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83805-7523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-946-8832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1153 SOUTHSIDE SCHOOL RD
-----------------------------------------------------
City | COCOLALLA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83813-6005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-715-5038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | 29842
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------