1528789153 NPI number — BELINDA ANN CHILDERS BSN, RN, CCRN, MA

Table of content: BELINDA ANN CHILDERS BSN, RN, CCRN, MA (NPI 1528789153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528789153 NPI number — BELINDA ANN CHILDERS BSN, RN, CCRN, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDERS
Provider First Name:
BELINDA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, CCRN, MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWOR
Provider Other First Name:
BELINDA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528789153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
815 N 6TH E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83647-2207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-580-2001
Provider Business Mailing Address Fax Number:
208-580-9993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N 6TH E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83647-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-580-2001
Provider Business Practice Location Address Fax Number:
208-580-9993
Provider Enumeration Date:
09/12/2022

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: 163W00000X , with the licence number:  N-31978 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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