Provider Demographics
NPI:1912550138
Name:HUHTALA, EDWIN (DNP/FNP)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:HUHTALA
Suffix:
Gender:M
Credentials:DNP/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-5420
Mailing Address - Country:US
Mailing Address - Phone:208-642-9376
Mailing Address - Fax:208-642-9598
Practice Address - Street 1:789 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1147
Practice Address - Country:US
Practice Address - Phone:541-473-2101
Practice Address - Fax:541-473-2668
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201911180NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily