Provider Demographics
NPI:1376899278
Name:BAHADAR, DENISE R (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:BAHADAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 N NYBORG WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1262
Mailing Address - Country:US
Mailing Address - Phone:208-392-8383
Mailing Address - Fax:866-575-9302
Practice Address - Street 1:2061 N NYBORG WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1262
Practice Address - Country:US
Practice Address - Phone:208-392-8383
Practice Address - Fax:866-575-9302
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1169A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily