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General NPI Number Information
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NPI Number | 1952186876
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Entity Type | Individual
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Provider Name | IMELDA JOAN WEDDINGTON NP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 13500 S PLEASANT VALLEY RD
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City | KUNA
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State | ID
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Zip | 83634-2709
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Country | US
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Telephone | 208-658-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 S ISLAND GLENN WAY
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City | EAGLE
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State | ID
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Zip | 83616-7111
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 77183
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License Number State | ID
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