Healthcare Provider Details

I. General information

NPI: 1770622946
Provider Name (Legal Business Name): NANCY M COONAN CFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD STE 104
BOISE ID
83706-1339
US

IV. Provider business mailing address

5911 ENSIGN AVE
GARDEN CITY ID
83714-1243
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-4749
  • Fax: 208-378-7519
Mailing address:
  • Phone: 208-376-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number00F622
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: