Organization Name: | HEALTHCARE WITH HEART LLC |
NPI Number: | 1053521344 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RONALD EUGENE CARROLL (OWNER) |
Mailing Address: | 823 Center Ave Payette |
State: | ID US |
Postal Code: | 836612535 |
Phone Number: | 2086423396 |
Fax Number: | 2086429060 |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | N19189 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |