Provider Demographics
NPI:1083067268
Name:ALJAYOUSHI, EULALIA ADRIANA (FNP-C)
Entity Type:Individual
Prefix:
First Name:EULALIA
Middle Name:ADRIANA
Last Name:ALJAYOUSHI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 E MIDDLE FORK RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406-8332
Mailing Address - Country:US
Mailing Address - Phone:208-403-6574
Mailing Address - Fax:
Practice Address - Street 1:1995 E 17TH ST STE 1
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6493
Practice Address - Country:US
Practice Address - Phone:208-357-9193
Practice Address - Fax:208-357-9173
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53513A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily