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General NPI Number Information
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NPI Number | 1144434556
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Entity Type | Individual
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Provider Name | LAURA JOANNE BAINBRIDGE FNP-C, APRN, MSN
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 203 W. MAIN STREET
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-336-7722
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Fax | 208-336-9284
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Provider Business Mailing Address
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Address Line | 203 W. MAIN STREET
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 208-336-7722
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Fax | 208-336-9284
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA242
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-1438A
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License Number State | ID
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