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General NPI Number Information
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NPI Number | 1861183329
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Entity Type | Individual
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Provider Name | SHAYNA STEWARD NP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 10200 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8900
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Country | US
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Telephone | 208-327-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 7 S WHEELER ST
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City | BOISE
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State | ID
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Zip | 83705-1605
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Country | US
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Telephone | 760-808-0335
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Fax |
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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 | 54252
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License Number State | ID
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