Provider Demographics
NPI:1568591204
Name:CLOSE, JOHN LINTON (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LINTON
Last Name:CLOSE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1509 N WHITLEY DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619
Mailing Address - Country:US
Mailing Address - Phone:208-452-5716
Mailing Address - Fax:208-452-5718
Practice Address - Street 1:1509 N WHITLEY DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619
Practice Address - Country:US
Practice Address - Phone:208-452-5716
Practice Address - Fax:208-452-5718
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDN24466163W00000X
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse