Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | NP511 | ID |
NPI | 1184653016 |
---|---|
Provider Name | Cheryl L Beaumont |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 14/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP511 | IDAHO STATE LICENSE # (01) | ID |