Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 56278 | ID |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 56278 | ID |
NPI | 1063934487 |
---|---|
Provider Name | Meeka J Bond |
First Address | Post Falls, ID 83854-5326 |
Second Address | Post Falls, ID 83854 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2017 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063934487 | (05) | ID |
2107175 | (05) | WA |