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General NPI Number Information
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NPI Number | 1538921630
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Entity Type | Organization
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Legal Business Name | CANYON PRIMARY CARE LLC
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1215 CHENEY DR W
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City | TWIN FALLS
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State | ID
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Zip | 83301-1203
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Country | US
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Telephone | 208-595-7563
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Fax | 949-695-4627
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Provider Business Mailing Address
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Address Line | 2657 E 3700 N
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City | TWIN FALLS
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State | ID
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Zip | 83301-0146
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Country | US
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Telephone | 208-595-7563
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Fax | 949-695-4627
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Authorized Official
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Title or Position | OWNER
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Name | HAILEE LI
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Credential | FNP-BC
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Telephone | 208-595-7563
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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 |
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License Number State |
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