Provider Demographics
NPI:1275256414
Name:SOENEN, TROY DAVID
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:DAVID
Last Name:SOENEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N ATLAS RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8332
Mailing Address - Country:US
Mailing Address - Phone:208-415-5218
Mailing Address - Fax:
Practice Address - Street 1:8500 N ATLAS RD
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8332
Practice Address - Country:US
Practice Address - Phone:208-415-5218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator