Individual
ERIC FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
191 ADDISON AVE, TWIN FALLS, ID 83301-5177
(208) 944-0369
Mailing address
191 ADDISON AVE, TWIN FALLS, ID 83301-5177
(208) 944-0369
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60627369
WA
363L00000X
Nurse Practitioner
NP-1692A
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
NP-1692A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376918383
IPN-IDAHO PHYSICIANS NETWORK
ID
Enumeration date
12/02/2015
Last updated
10/03/2023
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