Provider Demographics
NPI:1447491428
Name:JULIANNE NYE
Entity type:Organization
Organization Name:JULIANNE NYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-922-3623
Mailing Address - Street 1:847 WHITE BARN RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3348
Mailing Address - Country:US
Mailing Address - Phone:208-922-3623
Mailing Address - Fax:
Practice Address - Street 1:847 WHITE BARN RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3348
Practice Address - Country:US
Practice Address - Phone:208-922-3623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808148400Medicaid