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General NPI Number Information
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NPI Number | 1740750710
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Entity Type | Organization
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Legal Business Name | NURTURE LACTATION SUPPORT FOR WOMEN & INFANTS
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 5480 GLENEAGLES DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6315
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Country | US
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Telephone | 208-569-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 5480 GLENEAGLES DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6315
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Country | US
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Telephone | 208-569-9031
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | KRISTIE KARROUM
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Credential | FNP
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Telephone | 208-569-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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