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Provider Licensure Forms
Provider Licensure Forms
These forms are in PDF format. Click on the form you need, print, complete, and return to the Idaho EMS Bureau.
Address:
PO Box
83720
Boise
,
ID
83720-0036
Fax:
208-334-4015
Email:
EMSPROVLIC@dhw.idaho.gov
Initial Provider License
•
Initial Provider Application
(use for Initial and Reversion)
•
Idaho EMS Provider Reciprocity
Renewal Application with Guide
•
EMR Renewal Guide
•
EMT Basic Renewal Guide
•
AEMT Renewal Guide
•
Paramedic Renewal Guide
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Affiliation Change
•
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Copyright 2007 by Idaho Department of Health and Welfare