Individual provider Active NPI

Antonette Lynn Harvill, ARNP

  • Neonatal Nurse Practitioner
  • Boise, ID
National Provider Identifier
1073897849
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
62691 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 302-4600
Fax
(208) 302-4655
NPI assigned
Sep 28, 2011
Last updated
Jan 20, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X AP60217378 WA
Neonatal Nurse Practitioner 363LN0000X 62691 ID Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

888 Swift Blvd.
Richland, WA 99352
Phone (509) 946-4611

Other identifiers 2

IdentifierTypeStateIssuer
025904OtherWAKRMC L&I GROUP NUMBER
1073897849MedicaidWA

Other names 1

  • Antonette L Ciola Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120706000629 WA Practitioner - Nurse Practitioner 0143485615 Reassigns benefits to 1 organization
I20250123002043 ID Practitioner - Nurse Practitioner 0143485615 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prosser Public Hospital District of Benton County CurrentSince Aug 30, 2014 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Aug 30, 2014 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

Interoperability endpoints

  • Direct secure messaging: aharvill1107081@wm.providencedirect.org
  • Direct secure messaging: aharvill3990439@direct.trinity-health.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1073897849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-302-4600",
            "fax_number": "208-302-4655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "888 Swift Blvd.",
            "address_purpose": "LOCATION",
            "city": "Richland",
            "state": "WA",
            "postal_code": "99352",
            "country_code": "US",
            "telephone_number": "509-946-4611",
            "fax_number": "509-942-2887",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARVILL",
        "first_name": "ANTONETTE",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-28",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "WA",
            "license": "AP60217378",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "ID",
            "license": "62691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KRMC L&I GROUP NUMBER",
            "identifier": "025904",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073897849",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANTONETTE",
            "last_name": "CIOLA",
            "middle_name": "L",
            "credential": "NNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.