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General NPI Number Information
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NPI Number | 1346001377
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Entity Type | Organization
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Legal Business Name | MYFAMILYDOC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 1000 N CURTIS RD STE 105
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City | BOISE
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State | ID
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Zip | 83706-1345
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Country | US
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Telephone | 949-695-3813
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Fax |
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Provider Business Mailing Address
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Address Line | 2885 NW 10TH AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-3159
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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 | OWNER
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Name | DIMITRI SHCHADENKO
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Credential | FNP
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Telephone | 650-284-6595
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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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