Provider Demographics
NPI:1942369186
Name:MAHLER, ALPHA L (NP)
Entity Type:Individual
Prefix:
First Name:ALPHA
Middle Name:L
Last Name:MAHLER
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 1:366 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-8535
Mailing Address - Country:US
Mailing Address - Phone:208-436-6266
Mailing Address - Fax:208-678-0909
Practice Address - Street 1:1945 HILAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2714
Practice Address - Country:US
Practice Address - Phone:208-678-0900
Practice Address - Fax:208-678-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-267A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNPHV1OtherBLUE CROSS
ID000010171038OtherREGENCE BLUE SHIELD OF IDAHO
ID805371400Medicaid
ID000010171038OtherREGENCE BLUE SHIELD OF IDAHO
13424101Medicare PIN