Provider Demographics
NPI:1730182205
Name:REILING, JUNE (CNP)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:REILING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6259 W EMERALD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8731
Mailing Address - Country:US
Mailing Address - Phone:208-489-1900
Mailing Address - Fax:208-489-1929
Practice Address - Street 1:6259 W EMERALD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8731
Practice Address - Country:US
Practice Address - Phone:208-489-1900
Practice Address - Fax:208-489-1929
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1033A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1730182205OtherNPI
ID1730182205OtherNPI