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General NPI Number Information
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NPI Number | 1396121349
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S TREASURE VALLEY PEDIATRICS
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 450 W STATE ST STE 100
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City | EAGLE
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State | ID
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Zip | 83616-7055
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Country | US
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Telephone | 208-939-1035
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Fax | 208-939-8970
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Provider Business Mailing Address
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Address Line | 450 W STATE ST STE 100
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City | EAGLE
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State | ID
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Zip | 83616-7055
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Country | US
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Telephone | 208-939-1035
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Fax | 208-939-8970
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | ALISHA LAUREN MILLER
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Credential |
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Telephone | 208-939-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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