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General NPI Number Information
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NPI Number | 1043868995
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Entity Type | Organization
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Legal Business Name | SOUTHERN IDAHO FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 5524 S PINLAND AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-7353
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Country | US
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Telephone | 208-985-3864
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N MAIN ST UNIT 184
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City | MERIDIAN
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State | ID
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Zip | 83680-5013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FNP/OWNER
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Name | PAIGE ZIEMER
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Credential | FNP
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Telephone | 208-871-8768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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