Individual
THERESA MARIE KAUFMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
777 HOSPITAL WAY BLDG A, STE. 101, POCATELLO, ID 83201-2753
(208) 234-2001
(208) 232-2195
Mailing address
PO BOX O, POCATELLO, ID 83205-0049
(208) 234-2001
(208) 232-2195
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP160A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806131600
—
ID
Enumeration date
09/26/2005
Last updated
11/14/2008
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