IndividualActive
Benjamin Rae
NPI 1770051229 · Psychiatric/Mental Health Nurse Practitioner · Idaho Falls, ID
Provider details
- NPI number
- 1770051229
- Entity type
- Individual
- Primary specialty
- Psychiatric/Mental Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- No
- License
- AP60879306 (WA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
530 S Holmes Ave
Idaho Falls, ID 83401-5056
Phone: (208) 924-4360
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 955
Wilson, WY 83014-0955
Registry dates
- Enumerated
- 2018-11-02
- Last updated
- 2025-05-02
- Certified
- 2025-05-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.