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Contact Information

MOUNTAIN PINE DERMATOLOGY, PLLC
1576 W DEER CREST ST
STE. #100
MERIDIAN, ID83646
 Phone: 208-898-7467
 Fax: 208-314-0102
 Website: http://mtnpinederm.com
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for MOUNTAIN PINE DERMATOLOGY PLLC · (Female)

NPI Number 1659827665
Status Active
Credentials
Entity Individual
Enumeration date 08/30/2016
Last updated 07/05/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • ID License # O-0934
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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