=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750209052
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNOR TORMAN PMH-NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2026
-----------------------------------------------------
Last Update Date | 07/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S 3RD W
-----------------------------------------------------
City | SODA SPRINGS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83276-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-547-3341
-----------------------------------------------------
Fax | 208-547-2790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S 3RD W
-----------------------------------------------------
City | SODA SPRINGS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83276-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-547-3341
-----------------------------------------------------
Fax | 208-547-2790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2026057965
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------