# IDAHO STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ISU Meridian Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962095711
- **Authorized official:** CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (208) 373-1743

## Contact information

- **Practice address:** 1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
- **Practice address phone:** (208) 373-1734
- **Practice address fax:** (833) 499-1813
- **Mailing address:** 1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
- **Mailing address phone:** (208) 373-1734
- **Mailing address fax:** (833) 499-1813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2021
- **Last updated:** 08/27/2021