Basic Information
| Provider Information | |||||||||
| NPI: | 1912550138 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUHTALA | ||||||||
| FirstName: | EDWIN | ||||||||
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| Credential: | DNP/FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 NE 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | PAYETTE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836615420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086429376 | ||||||||
| FaxNumber: | 2086429598 | ||||||||
| Practice Location | |||||||||
| Address1: | 789 WASHINGTON ST W | ||||||||
| Address2: | |||||||||
| City: | VALE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979181147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414732101 | ||||||||
| FaxNumber: | 5414732668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2019 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201911180NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.