Individual
HYRUM DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
(208) 252-5621
(208) 648-4167
Mailing address
PO BOX 2516, POCATELLO, ID 83206-2516
(208) 252-5621
(208) 648-4167
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP-913A
ID
Other
Enumeration date
06/04/2009
Last updated
09/23/2025
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