Individual
COLETTE EGBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3320 S 25TH E, IDAHO FALLS, ID 83404-4606
(208) 656-1500
Mailing address
2908 N AZURE DR, IDAHO FALLS, ID 83401-5065
(208) 390-7909
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
58152
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58152
NP LICENSE
ID
Enumeration date
03/21/2018
Last updated
03/21/2018
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