Healthcare Provider Details

I. General information

NPI: 1669213047
Provider Name (Legal Business Name): BRITTANY TYSON BIANCHIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N IRONWOOD PL
COEUR D ALENE ID
83814-2670
US

IV. Provider business mailing address

2201 N IRONWOOD PL
COEUR D ALENE ID
83814-2670
US

V. Phone/Fax

Practice location:
  • Phone: 208-269-5311
  • Fax: 208-274-9125
Mailing address:
  • Phone: 208-269-5311
  • Fax: 208-274-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6961570
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN.0999756-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: