Provider Demographics
NPI:1932973351
Name:ENGER, MISTY R
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:R
Last Name:ENGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2245
Mailing Address - Country:US
Mailing Address - Phone:406-478-2085
Mailing Address - Fax:
Practice Address - Street 1:1842 YALE AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2245
Practice Address - Country:US
Practice Address - Phone:406-478-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty