Provider Demographics
NPI:1780150979
Name:HARCOURT, MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARCOURT
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 VILLAGE PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4172
Mailing Address - Country:US
Mailing Address - Phone:208-441-0767
Mailing Address - Fax:208-441-0367
Practice Address - Street 1:2114 VILLAGE PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4172
Practice Address - Country:US
Practice Address - Phone:208-441-0767
Practice Address - Fax:208-441-0367
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID61016363LF0000X
ID42111163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID61016OtherFAMILY NURSE PRACTITIONER
ID42111OtherREGISTERED NURSE