Provider Demographics
NPI:1194065730
Name:HARMONY, RUSSELL BOLTON (NP)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:BOLTON
Last Name:HARMONY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 W CURTISIAN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-672-4640
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:1859 S TOPAZ WAY STE 106
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4401
Practice Address - Country:US
Practice Address - Phone:208-672-4640
Practice Address - Fax:208-957-6300
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA774657163W00000X
CA21853363LF0000X
IDNP-1275A363LF0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily