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General NPI Number Information
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NPI Number | 1588038616
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Entity Type | Organization
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Legal Business Name | CARMEN HERNANDEZ RADFORD
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 3652 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7573
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Country | US
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Telephone | 208-419-0593
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Fax |
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Provider Business Mailing Address
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Address Line | 5451 THATCHER AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4935
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Country | US
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Telephone | 208-757-1854
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | CARMEN HERNANDEZ RADFORD
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Credential |
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Telephone | 208-757-1854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | NP-1660A
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License Number State | ID
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