Healthcare Provider Details

I. General information

NPI: 1831670629
Provider Name (Legal Business Name): KRISTEN ELIZABETH SANTANA AGNP-C, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN E KOLNES AGNP-PC,WHNP-BC

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N 1ST ST STE 240
BOISE ID
83702-6132
US

IV. Provider business mailing address

333 N 1ST ST STE 240
BOISE ID
83702-6132
US

V. Phone/Fax

Practice location:
  • Phone: 208-338-8900
  • Fax: 208-947-1190
Mailing address:
  • Phone: 208-338-8900
  • Fax: 208-947-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number57865
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number57865
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number57865
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number57865
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: