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General NPI Number Information
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NPI Number | 1972315646
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Entity Type | Organization
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Legal Business Name | STRAIGHTWAY HEALTH PLLC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 25427 HAVARD OAK PL
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City | CALDWELL
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State | ID
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Zip | 83607-5526
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Country | US
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Telephone | 208-405-0556
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Fax |
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Provider Business Mailing Address
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Address Line | 25427 HAVARD OAK PL
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City | CALDWELL
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State | ID
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Zip | 83607-5526
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Country | US
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Telephone | 208-405-0556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL BRIAN MCCONNELL
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Credential | PA
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Telephone | 714-595-4110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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