Individual
SUZANNE KEELE EDELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4702 W CHERRY CREEK ROAD, MOORE, ID 83255
(208) 554-2006
Mailing address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 554-2006
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
NP-325A
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP-325A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME1563990
CONTROLLED SUBSTANCE REG.
ID
01
—
N-10732
RN LICENSE
ID
01
—
NP-325A
ANP LICENSE
ID
Enumeration date
06/25/2007
Last updated
09/11/2025
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