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NPI Code Detail

MEDICARE: ANDREW W NISTLER

MEDICARE:   ANDREW W NISTLER
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
1363LF0000XFamily Nurse Practitioner2871990ID

General Provider Information

NPI Number : 1124973623
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW W NISTLER
Provider Business Mailing Address
First Line : 11688 N KENSINGTON AVE
Second Line :
City : HAYDEN
State : ID
Zip : 83835-7581
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1525 ADDISON AVE E STE A2
Second Line :
City : TWIN FALLS
State : ID
Zip : 83301-5300
Country : US
Telephone Number : 406-202-4333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ ANDREW W NISTLER ” Practice Location

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