Provider Demographics
NPI:1649927245
Name:WARD, ERIC DANIEL (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DANIEL
Last Name:WARD
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 BREEZY WAY
Mailing Address - Street 2:
Mailing Address - City:PRIEST RIVER
Mailing Address - State:ID
Mailing Address - Zip Code:83856
Mailing Address - Country:US
Mailing Address - Phone:512-796-5371
Mailing Address - Fax:
Practice Address - Street 1:6509 HIGHWAY 2 STE 101
Practice Address - Street 2:
Practice Address - City:PRIEST RIVER
Practice Address - State:ID
Practice Address - Zip Code:83856-6633
Practice Address - Country:US
Practice Address - Phone:280-448-2321
Practice Address - Fax:208-448-1317
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily