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General NPI Number Information
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NPI Number | 1780150979
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Entity Type | Individual
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Provider Name | MICHELLE HARCOURT FNP
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Gender | Female
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2114 VILLAGE PARK AVE STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4172
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Country | US
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Telephone | 208-441-0767
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Fax | 208-441-0367
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Provider Business Mailing Address
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Address Line | 2114 VILLAGE PARK AVE STE 200
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City | TWIN FALLS
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State | ID
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Zip | 83301-4172
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Country | US
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Telephone | 208-441-0767
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Fax | 208-441-0367
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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 | 61016
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 42111
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License Number State | ID
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