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NPI Code Detail

MEDICARE: NATHAN JOHN CHURCH PA-C

MEDICARE: NATHAN JOHN CHURCH PA-C
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
1363A00000XPhysician AssistantPA-266ID
2363AM0700XMedical Physician AssistantPA-266ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA-266OTHERIDSTATE LISCENSE
2PA00678OTHEROROR STATE LISCENSE

General Provider Information

NPI Number : 1386635977
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN JOHN CHURCH PA-C
Provider Business Mailing Address
First Line : 6052 W STATE ST
Second Line :
City : BOISE
State : ID
Zip : 83703-2739
Country : US
Telephone Number : 208-344-7799
Fax Number : 208-344-7152
Provider Business Practice Location Address
First Line : 6052 W STATE ST
Second Line :
City : BOISE
State : ID
Zip : 83703-2739
Country : US
Telephone Number : 208-344-7799
Fax Number : 208-344-7152
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 11/01/2023

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Directions to “ NATHAN JOHN CHURCH PA-C” Practice Location

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