MEDICARE: MS. BEVERLY A SCHIFFLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP-619A	ID

General Provider Information

NPI Number	:	1043290414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY A SCHIFFLER FNP

Provider Business Mailing Address
First Line	:	4074 S IRIONDO WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-5784
Country	:	US
Telephone Number	:	208-426-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 S PLYMOUTH AVE
Second Line	:
City	:	NEW PLYMOUTH
State	:	ID
Zip	:	83655-5523
Country	:	US
Telephone Number	:	208-278-3406
Fax Number	:	208-278-3418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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