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General NPI Number Information
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NPI Number | 1013352285
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Entity Type | Individual
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Provider Name | ALEXIS R SIDDOWAY NP
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Gender | Female
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 10/26/2013
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone | 208-535-4432
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 SUNLIGHT DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4807
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Country | US
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Telephone | 208-681-7399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | NP1309A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | N37740
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License Number State | ID
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