Individual provider Active NPI

Marianne Nelson, AG-ACNP

  • Nurse Practitioner
  • Idaho Falls, ID
National Provider Identifier
1861120180
Registry record updated Aug 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
56225 Issued in ID
Practice address
2381 E Sunnyside Rd
Idaho Falls, ID 83404-7521
Phone
(208) 904-4780
NPI assigned
Aug 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 56225 ID Primary

Addresses

Primary practice location

2381 E Sunnyside Rd
Idaho Falls, ID 83404-7521

Mailing address

3040 Tipperary LN
Idaho Falls, ID 83404-7317
Phone (801) 682-7947

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220901002881 ID Practitioner - Nurse Practitioner 1355725888 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Idaho Kidney Institute LLPGroup PAC ID 9032155312, 14 clinicians

Practice addresses (Care Compare)

4511 Zebe Ave
Chubbuck, ID 83202-4707
Phone (208) 904-4780

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Kidney Institute LLP Nephrology CurrentSince Aug 1, 2022 Accepting new patients
Snake River Hospitalists, LLC CurrentSince Nov 22, 2022 Accepting new patients
Transtreme, LLC Family PastSince Aug 1, 2022 Accepting new patients

Locations

1501 Hiland Ave
Ste M
Burley, ID 83318
Phone (208) 352-7555

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2381 E Sunnyside Rd
Idaho Falls, ID 83404
Phone (208) 523-8500

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

1259 Pier View Dr
Idaho Falls, ID 83402

Organizations & group practices 3

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1660435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660435200000",
    "number": "1861120180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 TIPPERARY LN",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047317",
            "telephone_number": "801-682-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2381 E SUNNYSIDE RD",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047521",
            "telephone_number": "208-904-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "MARIANNE",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-14",
        "last_updated": "2022-08-14",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "56225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.