Provider Demographics
NPI:1467854109
Name:WEBB, MATTHEW (APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:WEBB
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 S DEVELOPMENT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-5354
Mailing Address - Country:US
Mailing Address - Phone:208-387-5280
Mailing Address - Fax:
Practice Address - Street 1:3833 S DEVELOPMENT AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5354
Practice Address - Country:US
Practice Address - Phone:208-387-5280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9381306163W00000X
ID70118363LF0000X, 163W00000X
GARN 228872363LF0000X, 163W00000X
FLAPRN11006402363LF0000X, 363L00000X
FLPMD 526814146L00000X
GA8557146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic