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Organization
NORTHSTAR HEALTHCARE LLC
Active
Organization
NORTHSTAR HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA J. MASON FNPC (OWNER/FNPC)
(208) 529-2352
Entity
Organization
Contact information
Practice address
1995 E 17TH ST, STE 2, IDAHO FALLS, ID 83404-6493
(208) 529-2352
(208) 528-3332
Mailing address
1995 E 17TH ST, STE 2, IDAHO FALLS, ID 83404-6493
(208) 529-2352
(208) 528-3332
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP386A
ID
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806924200
—
ID
05
—
807185300
—
ID
01
—
DC1808
RAILROAD MEDICARE
—
Enumeration date
10/24/2006
Last updated
02/03/2012
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