Provider Demographics
NPI:1053454868
Name:PAMELA FIELDS NURSE PRACTITIONER PA
Entity Type:Organization
Organization Name:PAMELA FIELDS NURSE PRACTITIONER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-344-6080
Mailing Address - Street 1:PO BOX 16820
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83715-6820
Mailing Address - Country:US
Mailing Address - Phone:208-344-6080
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-344-6080
Practice Address - Fax:208-323-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1368987Medicare ID - Type Unspecified