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NPI Code Detail

MEDICARE: ALISA D. ORTEGA NP

MEDICARE: ALISA D. ORTEGA 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
1363LP0200XPediatric Nurse PractitionerNP242AID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D93724OTHERUPIN

General Provider Information

NPI Number : 1811184492
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISA D. ORTEGA NP
Provider Business Mailing Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-381-2222
Fax Number :
Provider Business Practice Location Address
First Line : 417 S 6TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-7632
Country : US
Telephone Number : 208-577-4460
Fax Number : 208-577-4469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2007
Last Update Date : 10/06/2012

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