IndividualActive
Randy Vawdrey, NP
NPI 1376568493 · Primary Care Nurse Practitioner · Pocatello, ID
Provider details
- NPI number
- 1376568493
- Entity type
- Individual
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Male
- Sole proprietor
- No
- License
- NP-659 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
495 Yellowstone Ave
Pocatello, ID 83201-4531
Phone: (208) 478-7422
Approximate (ZIP-level) locationGet directions
Mailing address
1743 Delmar Place
Pocatello, ID 83201
Registry dates
- Enumerated
- 2006-07-12
- Last updated
- 2007-07-09
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.