Provider Demographics
NPI:1366548661
Name:MASTERSON, TWYLA JEAN (RN, NP)
Entity type:Individual
Prefix:MS
First Name:TWYLA
Middle Name:JEAN
Last Name:MASTERSON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:TWYLA
Other - Middle Name:
Other - Last Name:STEINWAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:25201 N MCCOY RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-8667
Mailing Address - Country:US
Mailing Address - Phone:208-659-9234
Mailing Address - Fax:
Practice Address - Street 1:850 W IRONWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4903
Practice Address - Country:US
Practice Address - Phone:208-457-7078
Practice Address - Fax:208-457-7079
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-471A363LF0000X, 363L00000X
ID15400163W00000X
IDNP471A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366548661Medicaid
ID1366548661Medicaid
ID806107400OtherEDS GROUP