Provider Demographics
NPI:1821843020
Name:2M0TIV8, PLLC
Entity type:Organization
Organization Name:2M0TIV8, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:208-291-5553
Mailing Address - Street 1:1015 CALDWELL BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1717
Mailing Address - Country:US
Mailing Address - Phone:208-291-5553
Mailing Address - Fax:208-231-9958
Practice Address - Street 1:1015 CALDWELL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1717
Practice Address - Country:US
Practice Address - Phone:208-291-5553
Practice Address - Fax:208-231-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center