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General NPI Number Information
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NPI Number | 1821843020
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Entity Type | Organization
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Legal Business Name | 2M0TIV8, PLLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 1015 CALDWELL BLVD STE 3
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City | NAMPA
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State | ID
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Zip | 83651-1717
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Country | US
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Telephone | 208-291-5553
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Fax | 208-231-9958
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Provider Business Mailing Address
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Address Line | 1015 CALDWELL BLVD STE 3
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City | NAMPA
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State | ID
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Zip | 83651-1717
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Country | US
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Telephone | 208-291-5553
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Fax | 208-231-9958
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | REBECCA ANN MCDONALD
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Credential | FNP-BC
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Telephone | 208-291-5553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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