Individual provider · NPI-1

Bryce Wade Andersen, NP-C

Nurse Practitioner, Primary Care · Idaho Falls, ID

NPI number1174955306
StatusActive
Last updated in NPPESMar 11, 2024

Details

NPI
1174955306
Entity type
Individual (NPI-1)
Name
Bryce Wade Andersen
Credential
NP-C
Sex
Male
Sole proprietor
No
Enumeration date
Jul 30, 2013
Certification date
Mar 11, 2024
Last updated
Mar 11, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP2300X Nurse Practitioner, Primary CareNP1303AIDYes

Practice location

3385 Potomac Way
Idaho Falls, ID 83404-4978

Phone 208-522-7246

Mailing address

690 N 700 E
Firth, ID 83236-1134

Phone 208-521-3870

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