Individual
TY C WEBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1102 E LOCUST ST, EMMETT, ID 83617-2713
(208) 365-6004
Mailing address
1102 E LOCUST ST, EMMETT, ID 83617-2713
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5671037
ID
363LF0000X
Family Nurse Practitioner
Primary
201808187NP-PP
OR
Other
Enumeration date
11/30/2017
Last updated
12/13/2025
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