Provider Demographics
NPI:1811942816
Name:ANTINK, NAYA N (MD)
Entity type:Individual
Prefix:
First Name:NAYA
Middle Name:N
Last Name:ANTINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAYA
Other - Middle Name:N
Other - Last Name:JUUL-DAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3340 E 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:208-302-5800
Mailing Address - Fax:208-302-5855
Practice Address - Street 1:1072 N LIBERTY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8708
Practice Address - Country:US
Practice Address - Phone:208-302-5800
Practice Address - Fax:208-302-5855
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806974500Medicaid
ID806974500Medicaid
ID11286731Medicare PIN