Individual provider · Type 1 NPI
Mark Mitchell Roubidoux Ii, NP-C
Nurse Practitioner · Lewiston, ID
Practice location
336 Warner Dr Ste 4A
Lewiston, ID 83501-4441
Fax (877) 376-4040
Mailing address
320 E Neider Ave Ste 103
Coeur D Alene, ID 83815-6007
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner Primary | 363L00000X | 39235 (ID) |
Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…
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About NPI 1629685235
Mark Mitchell Roubidoux Ii, NP-C's National Provider Identifier is 1629685235, issued on Sep 28, 2020. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Lewiston, ID. The record was last updated on Sep 12, 2025.