Provider Demographics
NPI:1154298834
Name:NOURSE, JOE WILLIAM (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:WILLIAM
Last Name:NOURSE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15702 RIVERSIDE RD SPC 19
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-9648
Mailing Address - Country:US
Mailing Address - Phone:208-562-7106
Mailing Address - Fax:
Practice Address - Street 1:15702 RIVERSIDE RD SPC 19
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-9648
Practice Address - Country:US
Practice Address - Phone:208-562-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-20
Last Update Date:2025-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID43783364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Single Specialty