Provider Demographics
NPI:1851470785
Name:BIRD, DENISE LORAINE (NP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LORAINE
Last Name:BIRD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4710 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8414
Mailing Address - Country:US
Mailing Address - Phone:208-716-6445
Mailing Address - Fax:
Practice Address - Street 1:1970 E 17TH ST STE 111B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8046
Practice Address - Country:US
Practice Address - Phone:208-541-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1643A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR126813OtherNURSING LISCENSE