Provider Demographics
NPI:1962438382
Name:DAWIDCZIK, VALERIE A (NP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:DAWIDCZIK
Suffix:
Gender:F
Credentials:NP
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 7098
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-1098
Mailing Address - Country:US
Mailing Address - Phone:208-472-8117
Mailing Address - Fax:208-344-1926
Practice Address - Street 1:900 N LIBERTY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8704
Practice Address - Country:US
Practice Address - Phone:208-322-1686
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN17178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1345162Medicare ID - Type Unspecified
Q53385Medicare UPIN