Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 57638 | ID |
NPI | 1023516911 |
---|---|
Provider Name | Mr. Ryan Scott Harvey |
First Address | Nampa, ID 83687-7912 |
Second Address | Nampa, ID 83687-7912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 23/12/2020 |