Provider Demographics
NPI:1427152784
Name:ARAQUISTAIN, MARY K (MSN FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:ARAQUISTAIN
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1552 N CRESTMONT DR
Practice Address - Street 2:STE B
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2193
Practice Address - Country:US
Practice Address - Phone:208-957-5532
Practice Address - Fax:208-985-2261
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250108NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN-17210OtherSTATE OF IDAHO BOARD OF NURSING REGISTERED NURSE LICENSE
IDNP-1139AOtherSTATE OF IDAHO BOARD OF NURSING NURSE PRACTITIONER LICENSE
OR097006738RNOtherOREGON STATE BOARD OF NURSING REGISTERED NURSE LICENSE
OR200250108NPOtherOREGON STATE BOARD OF NURSING FAMILY NURSE PRACTITIONER LICENSE
0167918-22OtherANCC FAMILY NURSE PRACTITIONER BOARD CERTIFICATION