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General NPI Number Information
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NPI Number | 1902497795
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Entity Type | Organization
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Legal Business Name | MHP IDAHO LLC
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1534 IDAHO ST
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City | LEWISTON
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State | ID
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Zip | 83501-2573
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Country | US
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Telephone | 208-305-6131
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Fax |
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Provider Business Mailing Address
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Address Line | 1534 IDAHO ST
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City | LEWISTON
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State | ID
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Zip | 83501-2573
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Country | US
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Telephone | 208-305-6131
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Fax |
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | MEGAN L WALKER
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Credential |
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Telephone | 208-305-6131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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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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