Provider Demographics
NPI:1477850014
Name:UNDERWOOD, REX O II (RN)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:O
Last Name:UNDERWOOD
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13900 S PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2723
Mailing Address - Country:US
Mailing Address - Phone:208-333-0037
Mailing Address - Fax:
Practice Address - Street 1:13900 S PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2723
Practice Address - Country:US
Practice Address - Phone:208-333-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID59203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner