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General NPI Number Information
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NPI Number | 1356003800
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Entity Type | Individual
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Provider Name | KATHERINE OLIVIA ESTEP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 921 S 8TH AVE
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City | POCATELLO
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State | ID
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Zip | 83209-0002
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Country | US
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Telephone | 208-697-9439
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 245
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City | MALAD CITY
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State | ID
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Zip | 83252-0245
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Country | US
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Telephone | 208-697-9439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 69332
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License Number State | ID
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