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General NPI Number Information
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NPI Number | 1306536925
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Entity Type | Individual
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Provider Name | CARRIE SILVA CNIM, REEGT, RPSGT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 246 N CURLEW DR APT 9301
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City | AMMON
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State | ID
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Zip | 83401-1530
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Country | US
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Telephone | 208-305-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 YELLOWSTONE AVE # 191
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City | POCATELLO
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State | ID
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Zip | 83201-4312
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Country | US
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Telephone | 208-305-1233
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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 | 246ZE0500X
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Taxonomy Name | EEG Specialist/Technologist
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License Number | 7256
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number | 5050
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License Number State |
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