1427152784 NPI number — MS. MARY K ARAQUISTAIN MSN FNP

Table of content: MS. MARY K ARAQUISTAIN MSN FNP (NPI 1427152784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427152784 NPI number — MS. MARY K ARAQUISTAIN MSN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARAQUISTAIN
Provider First Name:
MARY
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427152784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 W STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83702-4039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1552 N CRESTMONT DR
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-957-5532
Provider Business Practice Location Address Fax Number:
208-985-2261
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200250108NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: N-17210 . This is a "STATE OF IDAHO BOARD OF NURSING REGISTERED NURSE LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NP-1139A . This is a "STATE OF IDAHO BOARD OF NURSING NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 097006738RN . This is a "OREGON STATE BOARD OF NURSING REGISTERED NURSE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 200250108NP . This is a "OREGON STATE BOARD OF NURSING FAMILY NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 0167918-22 . This is a "ANCC FAMILY NURSE PRACTITIONER BOARD CERTIFICATION" identifier . This identifiers is of the category "OTHER".




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