Provider Demographics
NPI:1306659867
Name:TORRES, MARIBEL (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:
Last Name:TORRES
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 1:1554 SHASTA ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2249
Mailing Address - Country:US
Mailing Address - Phone:208-851-3454
Mailing Address - Fax:
Practice Address - Street 1:1056 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3553
Practice Address - Country:US
Practice Address - Phone:208-851-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55074163WP2201X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Multi-Specialty