Provider Demographics
NPI:1285483537
Name:NORTH IDAHO PSYCHIATRY LLC
Entity type:Organization
Organization Name:NORTH IDAHO PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:RUFFO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:208-626-2433
Mailing Address - Street 1:1250 W IRONWOOD DR STE 333
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2682
Mailing Address - Country:US
Mailing Address - Phone:208-626-2433
Mailing Address - Fax:
Practice Address - Street 1:1250 W IRONWOOD DR STE 333
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2682
Practice Address - Country:US
Practice Address - Phone:208-626-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty