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Organization
MOUNTAIN STATES NEONATOLOGY, INC.
Active
Organization
MOUNTAIN STATES NEONATOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANETTE SANDERS (RCM DIRECTOR)
(800) 243-3839
Entity
Organization
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-7610
(208) 367-7616
Mailing address
1301 CONCORD TER, SUNRISE, FL 33323-2843
(800) 243-3839
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
—
NULL
207VM0101X
Maternal & Fetal Medicine Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
NULL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
2080P0203X
Pediatric Critical Care Medicine Physician
—
NULL
2080P0203X
Pediatric Critical Care Medicine Physician
—
—
363LN0000X
Neonatal Nurse Practitioner
—
NULL
363LN0000X
Neonatal Nurse Practitioner
—
—
Other
Enumeration date
07/27/2006
Last updated
10/23/2024
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