Provider Demographics
NPI:1104026178
Name:BARNUM, STEVEN JOSEPH (NP)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:BARNUM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2273 E GALA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7289
Mailing Address - Country:US
Mailing Address - Phone:208-898-8999
Mailing Address - Fax:208-898-8992
Practice Address - Street 1:2273 E GALA ST STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7289
Practice Address - Country:US
Practice Address - Phone:208-898-8999
Practice Address - Fax:208-898-8992
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP 17044363LF0000X, 363LX0106X
ID55135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health