Healthcare Provider Details

I. General information

NPI: 1528705647
Provider Name (Legal Business Name): EVELYN BORROMEO CONSIDINE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KOOTENAI CLINIC NEPHROLOGY 700 W. IRONWOOD DR. STE. 375
COEUR D'ALENE ID
83814
US

IV. Provider business mailing address

25043 N LANTERN HILL RD
RATHDRUM ID
83858-8752
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-6100
  • Fax: 208-625-6101
Mailing address:
  • Phone: 229-561-2401
  • Fax: 208-625-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number68494
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: