Provider Demographics
NPI:1710710165
Name:MEIRNDORF, JOHN TANNER (APRN-CNP,)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TANNER
Last Name:MEIRNDORF
Suffix:
Gender:M
Credentials:APRN-CNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 N STOKESBERRY PL
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1144
Mailing Address - Country:US
Mailing Address - Phone:208-906-2558
Mailing Address - Fax:833-973-3618
Practice Address - Street 1:2584 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1144
Practice Address - Country:US
Practice Address - Phone:208-906-2558
Practice Address - Fax:833-973-3618
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID8161577363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily