DONRAPHAEL WYNN (NPI# 1396188751) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396188751 |
| Entity Type | Individual |
| Full Name | DONRAPHAEL WYNN |
| Credential | M.D. |
| Practice Address |
1072 N Liberty St Ste 303 Boise ID 83704 |
| Mailing Address |
3340 E Goldstone Way Meridian ID 83642 |
| Practice Telephone | 2083024200 |
| Practice Fax Number | 2083024255 |
| Mailing Telephone | 2083024200 |
| Mailing Fax Number | 2083024255 |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2018-10-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 9164199-1205 | UT | Allopathic & Osteopathic Physicians |
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
M-14403 | ID | Allopathic & Osteopathic Physicians |
| N | 207WX0109X |
Ophthalmology Specialization: Neuro-ophthalmology |
9164199-1205 | UT | Allopathic & Osteopathic Physicians |
| Street Address |
1072 N LIBERTY ST STE 303 |
| City | BOISE |
| State | ID |
| Zip Code | 83704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487640561 | James D Redshaw | Psychiatry & Neurology | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2005-09-23 |
| 1316333107 | Karissa Deann Keenan | Obstetrics & Gynecology | 1072 N Liberty St, Ste 100, Boise, ID 83704 | 2015-04-08 |
| 1891184115 | Kristin Schmitt Gomes | Advanced Practice Midwife | 1072 N Liberty St, Ste 100, Boise, ID 83704 | 2015-01-12 |
| 1619385119 | Jessica M Herr | Nurse Practitioner | 1072 N Liberty St, Ste 200, Boise, ID 83704 | 2014-07-28 |
| 1093126229 | Colin Alan Lyness | Psychiatry & Neurology | 1072 N Liberty St, Ste 303, Boise, ID 83704 | 2014-05-09 |
| 1215362785 | Heather Ann Wilcke | Nurse Practitioner | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2013-09-03 |
| 1518214154 | Heather Marie Johnson | Nurse Practitioner | 1072 N Liberty St, Suite 203, Boise, ID 83704-8708 | 2012-08-14 |
| 1558620781 | Kandiss L Inman | Registered Nurse | 1072 N Liberty St, Suite 100, Boise, ID 83704-8708 | 2012-05-08 |
| 1942568118 | Daniel Prior | Surgery | 1072 N Liberty St, Ste 300, Boise, ID 83704 | 2012-04-25 |
| 1962709550 | Jane Kelsey Spencer | Clinical Nurse Specialist | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2011-02-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386903359 | Daniel B Simmons | Psychiatry & Neurology | 1072 N Liberty St Ste 303, Boise, ID 83704 | 2012-05-11 |
| 1053678342 | Daniel Clark Abenroth | Psychiatry & Neurology | 9th Floor -- Neurosciences, 190 E Bannock St., Boise, ID 83712-8905 | 2012-04-12 |
| 1427294545 | Thomas E Henson | Psychiatry & Neurology | 3183 S Temperance Way, Boise, ID 83706-5703 | 2008-12-18 |
| 1235381948 | Karin Lindholm, D.o. | Psychiatry & Neurology | 901 N Curtis Rd Ste 403, Boise, ID 83706-1342 | 2008-10-14 |
| 1548452683 | Sergei V Kashirny | Psychiatry & Neurology | 125 E Idaho St Ste 300, Neurology, Boise, ID 83712-6256 | 2007-08-13 |
| 1982691598 | Richard W Wilson | Psychiatry & Neurology | 999 N Curtis Rd, Ste 506, Boise, ID 83706-1336 | 2005-09-29 |
| 1487640561 | James D Redshaw | Psychiatry & Neurology | 1072 N Liberty St, Suite 303, Boise, ID 83704-2800 | 2005-09-23 |
| 1093126229 | Colin Alan Lyness | Psychiatry & Neurology | 1072 N Liberty St, Ste 303, Boise, ID 83704 | 2014-05-09 |
| 1174934327 | Benjamin Murray Stewart | Psychiatry & Neurology | 1072 N Liberty St Ste 303, Boise, ID 83704 | 2014-05-09 |
| 1265855118 | Jeremy Handy, M.d., Pllc | Psychiatry & Neurology | 413 N Allumbaugh St, Suite 101, Boise, ID 83704-9212 | 2014-01-29 |
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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.