PHYLLIS D TEZENO-BURRIS (NPI# 1073542056) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073542056 |
| Entity Type | Individual |
| Full Name | PHYLLIS D TEZENO-BURRIS |
| Credential | NP |
| Practice Address |
1000 E Park Blvd Ste 120 Boise ID 83712-7793 |
| Mailing Address |
1004 W Oceano Bello Dr Eagle ID 83616-6983 |
| Practice Telephone | 2083814100 |
| Mailing Telephone | 3106132235 |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2019-04-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | NP9976 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
57502 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1000 E PARK BLVD STE 120 |
| City | BOISE |
| State | ID |
| Zip Code | 83712-7793 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346734860 | Micah Thoreson | Nurse Practitioner | 1000 E Park Blvd Ste 120, Boise, ID 83712-7791 | 2018-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477016012 | Veranda At Barber Station LLC | Assisted Living Facility | 3266 E. Barber Valley Drive, Boise, ID 83712 | 2019-04-10 |
| 1891258612 | Mary Elizabeth Riedel | Occupational Therapist | 190 E Bancock St., Boise, ID 83712 | 2019-04-09 |
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1053898247 | Travis Dale Worwood | Social Worker | South Entrance, 1075 E. Park Blvd, Boise, ID 83712 | 2018-07-20 |
| 1689166761 | Kristen Nicole Ray | Social Worker | 109 E Bannock St, Boise, ID 83712 | 2018-06-04 |
| 1740706894 | Meghan Heitstuman | Social Worker | 190 E Bannock Street, Boise, ID 83712 | 2017-08-21 |
| 1942759725 | Kay Craig | Physical Therapist | 190 Bannock, Boise, ID 83712 | 2016-09-22 |
| 1235686395 | Sharon Bjornson | Physical Therapist | 190 East Bannack, Boise, ID 83712 | 2016-09-07 |
| 1033576491 | Heather Hussey | Genetic Counselor, MS | 100 E Idaho Street, Msti Genetics, Boise, ID 83712 | 2016-01-15 |
| 1295139137 | Amie Bartholomeus | Massage Therapist | 100 East Idaho Street, St Luke's Mountain States Tumor Institute, Boise, ID 83712 | 2014-10-21 |
| Find all providers in zip 83712 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568061398 | Nicolette A Eberline | Nurse Practitioner | 4228 W Guard St Bldg 665, Boise, ID 83705-8049 | 2020-10-22 |
| 1013522275 | Beau Lee | Nurse Practitioner | 2900 N Burton St, Boise, ID 83704-5314 | 2020-09-14 |
| 1588277529 | Tauna Marie Young | Nurse Practitioner | 1681 S Kimball Way, Boise, ID 83709-1654 | 2020-08-28 |
| 1497367114 | Lindsay Ruggles | Nurse Practitioner | 1105 S Federal Way, Boise, ID 83705-2546 | 2020-08-24 |
| 1265056014 | Brynn Crisp | Nurse Practitioner | 1075 N Curtis Rd Ste 100, Boise, ID 83706-1348 | 2020-06-07 |
| 1518592674 | Amber Lynn Gillette | Nurse Practitioner | 1111 S Orchard St Ste 251, Boise, ID 83705-1964 | 2020-03-10 |
| 1265062806 | Jamie Watts | Nurse Practitioner | 5353 W Hill Rd, Boise, ID 83703-2943 | 2020-01-23 |
| 1730654435 | Melissa Gaffrey | Nurse Practitioner | 500 S 8th St, Boise, ID 83702-7107 | 2018-10-09 |
| 1659876399 | Dixie Jean Skinner | Nurse Practitioner | 10583 W. Lake Hazel Rd., Boise, ID 83709-8370 | 2018-03-26 |
| 1063912202 | Devon Moser | Nurse Practitioner | 901 N Curtis Rd Ste 100, Boise, ID 83706-1339 | 2018-02-14 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.