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General NPI Number Information
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NPI Number | 1801008305
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Entity Type | Individual
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Provider Name | VANESSA IRENE BIZIMANA NP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 3217 W BAVARIA ST
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City | EAGLE
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State | ID
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Zip | 83616-5171
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Country | US
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Telephone | 208-302-6200
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Fax | 208-302-6245
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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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 | NP1013A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP30007712
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License Number State | WA
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