Active NPI
Shauna Lacow
- Family Nurse Practitioner
- Meridian, ID
National Provider Identifier
1609396282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 55964
- Practice address
- 1525 E Leighfield Dr # 150
Meridian, ID 83646-5371 - Phone
- (208) 888-1199
- NPI assigned
- Jun 23, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 55964 | ID | Primary |
Addresses
Primary practice location
1525 E Leighfield Dr # 150
Meridian, ID 83646-5371
Mailing address
1525 E Leighfield Dr # 150
Meridian, ID 83646-5371
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171027002462 | ID | Practitioner - Nurse Practitioner | 9234405713 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55964 | ID | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David J Butuk MD PA | Current | Accepting new patients | |
| Emergency Responders Health Center, LLC | Past | Accepting new patients |
Locations
1525 E Leigh Field Dr
Ste 150
Meridian, ID 83646
Phone (208) 888-1199
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Primary Care Clinic/Center
- Boise, ID
- NPI 1912189481
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498176000000",
"number": "1609396282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 E LEIGHFIELD DR # 150",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 E LEIGHFIELD DR # 150",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836465371",
"telephone_number": "208-888-1199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACOW",
"first_name": "SHAUNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-23",
"last_updated": "2017-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "ID",
"license": "55964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.