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General NPI Number Information
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NPI Number | 1588522189
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Entity Type | Individual
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Provider Name | RYAN NATHANIEL BOPP NP-C
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 5633 N LIDGERWOOD ST
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City | SPOKANE
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State | WA
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Zip | 99208-1224
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Country | US
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Telephone | 509-482-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 9383 W AUTUMN LN
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City | POCATELLO
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State | ID
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Zip | 83204-7227
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Country | US
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Telephone | 208-232-9403
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 7871063
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7871063
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License Number State | ID
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