MEDICARE: PAMELA H ARCHULETA NP

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	163W00000X	Registered Nurse	NP599A	ID
2	363LF0000X	Family Nurse Practitioner	NP599A	ID

General Provider Information

NPI Number	:	1578518676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA H ARCHULETA NP

Provider Business Mailing Address
First Line	:	4696 W OVERLAND RD
Second Line	:	SUITE 236
City	:	BOISE
State	:	ID
Zip	:	83705
Country	:	US
Telephone Number	:	208-850-5516
Fax Number	:	208-884-8094

Provider Business Practice Location Address
First Line	:	4696 W OVERLAND RD
Second Line	:	SUITE 236
City	:	BOISE
State	:	ID
Zip	:	83705-2845
Country	:	US
Telephone Number	:	208-850-5516
Fax Number	:	208-884-8094

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	12/09/2013

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