MEDICARE: SHAYNA LARAE HARDING APRN

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	207Q00000X	Family Medicine Physician	55855	ID

General Provider Information

NPI Number	:	1043880669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYNA LARAE HARDING APRN

Provider Business Mailing Address
First Line	:	652 W MAPLE ST
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-5103
Country	:	US
Telephone Number	:	208-221-9992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 CALL CREEK DR # A
Second Line	:
City	:	POCATELLO
State	:	ID
Zip	:	83201-3000
Country	:	US
Telephone Number	:	208-232-1000
Fax Number	:	208-232-1006

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

Provider Enumeration Date	:	06/27/2021
Last Update Date	:	04/06/2023

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Directions to “ SHAYNA LARAE HARDING APRN” Practice Location

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