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General NPI Number Information
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NPI Number | 1629334651
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Entity Type | Individual
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Provider Name | SUSAN L RALPH NP
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 14 S BALTIC PL SUITE 106
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City | MERIDIAN
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State | ID
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Zip | 83642-5935
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Country | US
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Telephone | 208-887-4872
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Fax | 208-887-6331
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Provider Business Mailing Address
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Address Line | 4914 ASBURY WAY
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City | CALDWELL
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State | ID
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Zip | 83607-7908
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Country | US
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Telephone | 208-695-3587
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | N-45447
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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 | TAP4415
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License Number State | AZ
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