Individual
VADIM P PUSTYNOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
700 W IRONWOOD DR STE 120, COEUR D ALENE, ID 83814-4405
(208) 625-3640
(208) 625-3645
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-3640
(208) 625-3645
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
26NJ01002700
NJ
363LF0000X
Family Nurse Practitioner
Primary
NP66228
ID
Other
Enumeration date
01/13/2020
Last updated
04/24/2024
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