Provider Demographics
NPI:1497356018
Name:NARVAIZA - FITZHUGH, MIDEN YOSUNE
Entity Type:Individual
Prefix:
First Name:MIDEN
Middle Name:YOSUNE
Last Name:NARVAIZA - FITZHUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 W 500 S
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-8607
Mailing Address - Country:US
Mailing Address - Phone:208-431-1399
Mailing Address - Fax:
Practice Address - Street 1:2271 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2960
Practice Address - Country:US
Practice Address - Phone:208-431-1399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)