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General NPI Number Information
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NPI Number | 1912516303
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Entity Type | Organization
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Legal Business Name | NOVA INTEGRATIVE HEALTH
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 229 E LOGAN ST
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City | CALDWELL
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State | ID
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Zip | 83605-4835
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Country | US
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Telephone | 208-504-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 229 E LOGAN ST
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City | CALDWELL
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State | ID
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Zip | 83605-4835
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Country | US
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Telephone | 208-504-5959
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JOHARY RODRIGUEZ
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Credential | FNP, PMHNP-BC
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Telephone | 208-504-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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