# NORTHSTAR HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598849051
- **Authorized official:** LAURA J. MASON FNPC (OWNER/FNPC)
- **Authorized official phone:** (208) 529-2352

## Contact information

- **Practice address:** 1995 E 17TH ST, STE 2, IDAHO FALLS, ID 83404-6493
- **Practice address phone:** (208) 529-2352
- **Practice address fax:** (208) 528-3332
- **Mailing address:** 1995 E 17TH ST, STE 2, IDAHO FALLS, ID 83404-6493
- **Mailing address phone:** (208) 529-2352
- **Mailing address fax:** (208) 528-3332

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | NP386A | ID | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 02/03/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 806924200 | — | ID |
| 05 | — | 807185300 | — | ID |
| 01 | — | DC1808 | RAILROAD MEDICARE | — |