Provider Demographics
NPI:1396790606
Name:NANAVATI, HEIDI L (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:NANAVATI
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 44464
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0464
Mailing Address - Country:US
Mailing Address - Phone:208-506-3665
Mailing Address - Fax:208-534-5056
Practice Address - Street 1:6590 W NORWOOD DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8765
Practice Address - Country:US
Practice Address - Phone:208-506-3665
Practice Address - Fax:208-534-5056
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334833363LF0000X
ID65331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1225613375Medicaid
NY02773182Medicaid
NM236620OtherLICENSE
NYQ70845Medicare UPIN