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General NPI Number Information
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NPI Number | 1124973623
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Entity Type | Individual
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Provider Name | ANDREW W NISTLER
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Gender | Male
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 1525 ADDISON AVE E STE A2
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City | TWIN FALLS
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State | ID
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Zip | 83301-5300
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Country | US
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Telephone | 406-202-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 11688 N KENSINGTON AVE
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City | HAYDEN
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State | ID
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Zip | 83835-7581
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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 |
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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 | 2871990
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License Number State | ID
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