Provider Demographics
NPI:1912871435
Name:BISTRICEANU, MIHAI
Entity type:Individual
Prefix:
First Name:MIHAI
Middle Name:
Last Name:BISTRICEANU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5356 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8408
Mailing Address - Country:US
Mailing Address - Phone:208-999-6158
Mailing Address - Fax:
Practice Address - Street 1:5356 CHERRY LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8408
Practice Address - Country:US
Practice Address - Phone:208-999-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker