Provider Demographics
NPI:1114737921
Name:SCRIVNER, ADREEANNA KAYE (RN)
Entity type:Individual
Prefix:
First Name:ADREEANNA
Middle Name:KAYE
Last Name:SCRIVNER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4680 N MCKINLEY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1608
Mailing Address - Country:US
Mailing Address - Phone:208-602-2503
Mailing Address - Fax:
Practice Address - Street 1:1520 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4085
Practice Address - Country:US
Practice Address - Phone:208-947-7700
Practice Address - Fax:208-947-7701
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID39778163WP2201X
OR202100022RN163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care