Most Relevant Information
Provider Data
| NPI Number: | 1003638255 |
| Provider Name: | HEIDI ANN FANSLOW PMHNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 3861978 |
Most Important Dates
| Enumeration Date: | 10/29/2024 |
| Last Updated: | 10/29/2024 |
Provider Practice Location
6830 N AGRARIAN AVE
MERIDIAN
ID
836464532
Practice Location Phone/Fax
| Phone: | 2539518331 |
| Fax: |
Provider Mailing Location
6830 N AGRARIAN AVE
MERIDIAN
ID
836464532
Provider Mailing Phone/Fax
| Phone: | 2539518331 |
| Fax: |