Provider Demographics
NPI:1649506163
Name:NEUENSCHWANDER, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:NEUENSCHWANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3013
Mailing Address - Country:US
Mailing Address - Phone:208-323-7588
Mailing Address - Fax:206-202-8007
Practice Address - Street 1:6000 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3013
Practice Address - Country:US
Practice Address - Phone:208-323-7588
Practice Address - Fax:206-202-8007
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator