CMS NPPES uses NUCC taxonomy code 363LF0000X for provider records classified as Family within Nurse Practitioner. The taxonomy identifies the category reported on the NPI record; it does not by itself verify services offered, current...
ID license #59037taxonomy 363LF0000X
Registered Nurse
(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or...
ID license #47201taxonomy 163W00000X
Identifiers
Type
Value
Notes
05 (ID)
1003315789
Medicare directory context
Attributes below come from the CMS Doctors & Clinicians dataset used by Medicare Care Compare,
retrieved 2026-10-12. They apply only to this clinician's public Medicare listing.
Medicare specialties
Nurse Practitioner
Telehealth
Listed by CMS
Confirm current availability with the practice
Largest Medicare group
87 members
Largest listed enrollment group
Facility affiliations reported by CMS
North Idaho Day Surgery Llc
Medicare listing data does not guarantee that a clinician is accepting new patients or that a service is covered.
View the CMS dataset →
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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