MEDICARE: TREASURE VALLEY HEALTHCARE PLLC

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	363LA2200X	Adult Health Nurse Practitioner
2	363LG0600X	Gerontology Nurse Practitioner

General Provider Information

NPI Number	:	1336762566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREASURE VALLEY HEALTHCARE PLLC

Provider Business Mailing Address
First Line	:	5108 N MAIDSTONE WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-1367
Country	:	US
Telephone Number	:	208-577-8672
Fax Number	:	208-939-6106

Provider Business Practice Location Address
First Line	:	1120 S RACKHAM WAY
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1092
Country	:	US
Telephone Number	:	208-577-8672
Fax Number	:	208-209-6058

Authorized Official
Title or Position	:	CEO
Name	:	CANDICE ELAINE ADAMS
Credential	:	DNP
Telephone Number	:	208-577-8672

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	07/29/2025

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Directions to “TREASURE VALLEY HEALTHCARE PLLC ” Practice Location

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