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General NPI Number Information
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NPI Number | 1407546898
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Entity Type | Individual
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Provider Name | MARY ELIZABETH VERHAEGHE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 621 N MAIN ST
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City | BELLEVUE
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State | ID
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Zip | 83313-5093
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Country | US
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Telephone | 208-725-3145
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Fax | 208-725-3146
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Provider Business Mailing Address
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Address Line | 621 N MAIN ST
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City | BELLEVUE
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State | ID
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Zip | 83313-5093
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Country | US
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Telephone | 208-725-3145
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Fax | 208-725-3146
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 4871142
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License Number State | ID
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