Provider Demographics
NPI:1699767004
Name:EDMO, HELENE P (FNP)
Entity type:Individual
Prefix:
First Name:HELENE
Middle Name:P
Last Name:EDMO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2377
Mailing Address - Country:US
Mailing Address - Phone:208-232-7862
Mailing Address - Fax:208-232-7869
Practice Address - Street 1:85 S 5TH W
Practice Address - Street 2:
Practice Address - City:LAVA HOT SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83246
Practice Address - Country:US
Practice Address - Phone:208-776-5202
Practice Address - Fax:208-776-5614
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP367A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNPYJ3OtherBLUE CROSS - MCCAMMON
IDNPLX2OtherBLUE CROSS - ABERDEEN
IDNPLV6OtherBLUE CROSS - DOWNEY
IDNPLU9OtherBLUE CROSS - AM FALLS
IDNPLW4OtherBLUE CROSS OF ID - LAVA
IDNPLY0OtherBLUE CROSS - POCATELLO
ID1342101Medicare PIN
IDNPLX2OtherBLUE CROSS - ABERDEEN
ID1342104Medicare PIN
ID13421051Medicare PIN
IDNPLV6OtherBLUE CROSS - DOWNEY
IDP00099232Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ID1342103Medicare PIN