Provider Demographics
NPI:1902491467
Name:YELLOW DAISY, PLLC
Entity Type:Organization
Organization Name:YELLOW DAISY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLONQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:BCNP-PMHNP
Authorized Official - Phone:208-715-6709
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:ID
Mailing Address - Zip Code:83236-0061
Mailing Address - Country:US
Mailing Address - Phone:208-715-6709
Mailing Address - Fax:
Practice Address - Street 1:112 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:ID
Practice Address - Zip Code:83236-1168
Practice Address - Country:US
Practice Address - Phone:208-715-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-06
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty