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General NPI Number Information
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NPI Number | 1518762574
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Entity Type | Individual
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Provider Name | AUSTIN WOOLARD NP
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Gender | Male
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 415 6TH STREET
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City | LEWISTON
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State | ID
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Zip | 83501-2434
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Country | US
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Telephone | 208-799-5226
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Fax | 208-799-5798
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Provider Business Mailing Address
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Address Line | 415 6TH ST
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City | LEWISTON
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State | ID
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Zip | 83501-2434
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Country | US
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Telephone | 208-750-7462
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Fax | 208-750-7467
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4871146
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License Number State | ID
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