Provider Demographics
NPI:1700879459
Name:HUFFINE, CORY J (NP)
Entity Type:Individual
Prefix:MR
First Name:CORY
Middle Name:J
Last Name:HUFFINE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:3340 EAST GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1055 N CURTIS ROAD
Practice Address - Street 2:S6
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-6048
Practice Address - Fax:208-367-6022
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-704363LF0000X
IDNP-704A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ16768Medicare UPIN