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General NPI Number Information
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NPI Number | 1124377791
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Entity Type | Individual
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Provider Name | MARY CATHERINE PRICE MS, APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 208-781-2576
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 S HUDSON AVE # 301
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City | BOISE
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State | ID
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Zip | 83705-4247
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Country | US
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Telephone | 208-440-5297
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1214A
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License Number State | ID
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