=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669321915
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY MAE NEGRON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 413 N ALLUMBAUGH ST STE 101
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83704-9219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-323-1125
-----------------------------------------------------
Fax | 208-323-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 413 N ALLUMBAUGH ST STE 101
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83704-9219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-323-1125
-----------------------------------------------------
Fax | 208-323-9601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 75555
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------