Provider Demographics
NPI:1447246905
Name:PETERS, HEIDI S (NP)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1394
Mailing Address - Country:US
Mailing Address - Phone:208-378-0080
Mailing Address - Fax:208-378-0259
Practice Address - Street 1:901 N CURTIS RD
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1394
Practice Address - Country:US
Practice Address - Phone:208-378-0080
Practice Address - Fax:208-378-0259
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-425A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1215061734Medicaid
ID1342591Medicare PIN
S87885Medicare UPIN