Provider Demographics
NPI:1073897849
Name:HARVILL, ANTONETTE LYNN (ARNP)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:LYNN
Last Name:HARVILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANTONETTE
Other - Middle Name:L
Other - Last Name:CIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-302-4600
Practice Address - Fax:208-302-4655
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60217378363LN0000X
ID62691363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA025904OtherKRMC L&I GROUP NUMBER
WA1073897849Medicaid
WA025904OtherKRMC L&I GROUP NUMBER