MEDICARE: MRS. TERI ANN MEADOWS DNP

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	363L00000X	Nurse Practitioner	34318	ID

General Provider Information

NPI Number	:	1457846206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERI ANN MEADOWS DNP

Provider Business Mailing Address
First Line	:	4933 N SUNDERLAND DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-2263
Country	:	US
Telephone Number	:	208-869-2630
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S EAGLE RD STE 3211
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6356
Country	:	US
Telephone Number	:	208-706-5930
Fax Number	:	208-706-5942

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

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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