Provider Demographics
NPI:1558666172
Name:HOWARD, GREGORY SCOTT (NP-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:HOWARD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9548 W CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2219
Mailing Address - Country:US
Mailing Address - Phone:208-631-0563
Mailing Address - Fax:208-350-6806
Practice Address - Street 1:9548 W CHADWICK DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-2219
Practice Address - Country:US
Practice Address - Phone:208-631-0563
Practice Address - Fax:208-350-6806
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1051A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily