Provider Demographics
NPI:1447702683
Name:BEVERLEE K FURNER, NP PLLC
Entity type:Organization
Organization Name:BEVERLEE K FURNER, NP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FURNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-850-1338
Mailing Address - Street 1:9858 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5210
Mailing Address - Country:US
Mailing Address - Phone:208-286-9471
Mailing Address - Fax:208-286-0565
Practice Address - Street 1:9858 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5210
Practice Address - Country:US
Practice Address - Phone:208-286-9471
Practice Address - Fax:208-286-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID881-A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty