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NPI Code Detail

MEDICARE: TY C WEBER FNP-C

MEDICARE: TY C WEBER FNP-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
1363L00000XNurse Practitioner5671037ID
2363LF0000XFamily Nurse Practitioner201808187NP-PPOR

General Provider Information

NPI Number : 1457865388
Entity Type Code : Individual
Provider Name (Legal Business Name) : TY C WEBER FNP-C
Provider Business Mailing Address
First Line : 1102 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2713
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1102 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2713
Country : US
Telephone Number : 208-365-6004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2017
Last Update Date : 12/13/2025

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Directions to “ TY C WEBER FNP-C” Practice Location

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