Basic Information
| Provider Information | |||||||||
| NPI: | 1699767004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDMO | ||||||||
| FirstName: | HELENE | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2377 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832062377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082327862 | ||||||||
| FaxNumber: | 2082327869 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 S 5TH W | ||||||||
| Address2: | |||||||||
| City: | LAVA HOT SPRINGS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087765202 | ||||||||
| FaxNumber: | 2087765614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | NP367A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | NPYJ3 | 01 | ID | BLUE CROSS - MCCAMMON | OTHER | NPLX2 | 01 | ID | BLUE CROSS - ABERDEEN | OTHER | NPLV6 | 01 | ID | BLUE CROSS - DOWNEY | OTHER | NPLU9 | 01 | ID | BLUE CROSS - AM FALLS | OTHER | NPLW4 | 01 | ID | BLUE CROSS OF ID - LAVA | OTHER | NPLY0 | 01 | ID | BLUE CROSS - POCATELLO | OTHER |