Individual
LAURA MATJASICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1505 MADRONA ST N BLDG 1200, TWIN FALLS, ID 83301-8334
(208) 886-0774
Mailing address
1505 MADRONA ST N BLDG 1200, TWIN FALLS, ID 83301-8334
(208) 886-0774
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5673235-4405
UT
363LP2300X
Primary Care Nurse Practitioner
55385
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-385
APRN
ID
01
—
5673235-4405
NA
UT
Enumeration date
07/21/2014
Last updated
05/12/2026
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