Provider Demographics
NPI:1548220874
Name:PETERSON, FAITH YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:YOUNG
Last Name:PETERSON
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:PO BOX 9
Mailing Address - Street 2:211 16TH AVENUE NORTH
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-0009
Mailing Address - Country:US
Mailing Address - Phone:208-467-4431
Mailing Address - Fax:208-467-4684
Practice Address - Street 1:201 MAIN
Practice Address - Street 2:
Practice Address - City:MARSING
Practice Address - State:ID
Practice Address - Zip Code:83639
Practice Address - Country:US
Practice Address - Phone:208-896-4159
Practice Address - Fax:208-896-4917
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILNP296A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1344276Medicare ID - Type UnspecifiedCIGNA
1344274Medicare ID - Type UnspecifiedCIGNA
P94297Medicare UPIN
1344273Medicare ID - Type UnspecifiedCIGNA
1344275Medicare ID - Type UnspecifiedCIGNA