Individual
RYAN ENGLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1957 E 17TH ST, IDAHO FALLS, ID 83404-6429
(208) 523-1100
(208) 523-1317
Mailing address
3918 E HAZELWOOD WAY, AMMON, ID 83406-1201
(208) 357-8403
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60967
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60967
—
ID
Enumeration date
07/10/2019
Last updated
07/10/2019
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