Individual
MS. DEBRA COLLEEN MYKKANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
700 W IRONWOOD DR, SUITE 155, COEUR D ALENE, ID 83814-2656
(208) 667-0585
(208) 667-0876
Mailing address
700 W IRONWOOD DR, SUITE 155, COEUR D ALENE, ID 83814-2656
(208) 667-0585
(208) 667-0876
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP306A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016720
REGENCE BLUE SHIELD
ID
01
—
000010016721
REGENCE BLUE SHIELD
ID
05
—
004376300
—
ID
05
—
1548346935
—
MT
05
—
9645896
—
WA
05
—
NP772ID
—
AK
01
—
NPKN7
BLUE CROSS
ID
01
—
NPPR4
BLUE CROSS OF IDAHO
ID
Enumeration date
10/27/2006
Last updated
12/18/2013
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