Provider Demographics
NPI:1588401160
Name:DOWNTAIN, JOHN (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DOWNTAIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7635
Mailing Address - Country:US
Mailing Address - Phone:208-704-0241
Mailing Address - Fax:
Practice Address - Street 1:615 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7635
Practice Address - Country:US
Practice Address - Phone:208-704-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID64030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse