Healthcare Provider Details

I. General information

NPI: 1679635478
Provider Name (Legal Business Name): KIMBERLY MAE LABRONTE NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY MAE HORNS NNP

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 518-520-8625
  • Fax: 208-625-6892
Mailing address:
  • Phone: 208-625-5085
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP62467
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: