Individual
ADRIAN AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, NP
Contact information
Practice address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(541) 539-1124
Mailing address
314 BADIOLA ST, CALDWELL, ID 83605-4389
(541) 539-1124
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
53602
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53602
IDAHO BOARD OF NURSING
ID
Enumeration date
06/14/2021
Last updated
07/13/2022
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