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NPI Code Detail

MEDICARE: MR. CORY J HUFFINE N.P.

MEDICARE: MR. CORY J HUFFINE N.P.
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
1363LF0000XFamily Nurse PractitionerNP-704ID
2363L00000XNurse PractitionerNP-704AID

General Provider Information

NPI Number : 1700879459
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CORY J HUFFINE N.P.
Provider Business Mailing Address
First Line : 3340 EAST GOLDSTONE WAY
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-1026
Country : US
Telephone Number : 208-367-5170
Fax Number : 208-367-5180
Provider Business Practice Location Address
First Line : 1055 N CURTIS ROAD
Second Line : S6
City : BOISE
State : ID
Zip : 83706-1309
Country : US
Telephone Number : 208-367-6048
Fax Number : 208-367-6022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2005
Last Update Date : 11/15/2012

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