Active NPI
Brooke Dyal
- Registered Nurse
- Boise, ID
National Provider Identifier
1659060317
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 67171
- Practice address
- 417 S 6TH St
Boise, ID 83702 - Phone
- (208) 577-4460
- NPI assigned
- May 8, 2023
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 67171 | ID | Primary |
Addresses
Primary practice location
417 S 6TH St
Boise, ID 83702
Mailing address
12193 S Red Hawk PL
Nampa, ID 83686
Phone (503) 313-1214
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67171 | ID | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1659060317",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12193 S RED HAWK PL",
"city": "NAMPA",
"state": "ID",
"postal_code": "83686",
"telephone_number": "503-313-1214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "417 S 6TH ST",
"city": "BOISE",
"state": "ID",
"postal_code": "83702",
"telephone_number": "208-577-4460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYAL",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "67171",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.