Provider Demographics
NPI:1235336769
Name:HUSKINSON, JOE (RNFA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:HUSKINSON
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 FERRIS LN
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3316
Mailing Address - Country:US
Mailing Address - Phone:208-313-2516
Mailing Address - Fax:
Practice Address - Street 1:2233 FERRIS LN
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3316
Practice Address - Country:US
Practice Address - Phone:208-313-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN31712174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist