Provider Demographics
NPI:1093101438
Name:MERIDIAN FAMILY MEDICINE
Entity Type:Organization
Organization Name:MERIDIAN FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-530-1087
Mailing Address - Street 1:ISU RIDGE CRST
Mailing Address - Street 2:APT L2
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-530-1087
Mailing Address - Fax:888-415-9555
Practice Address - Street 1:444 HOSPITAL WAY
Practice Address - Street 2:ROOM 219
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-2745
Practice Address - Country:US
Practice Address - Phone:208-530-1087
Practice Address - Fax:888-415-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty