Individual
MS. KELLEEN LOUISE FAKENBRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8324 W NORTHVIEW ST, SUITE 100, BOISE, ID 83704-7184
(208) 376-8337
(208) 376-8344
Mailing address
8324 W NORTHVIEW ST, SUITE 101, BOISE, ID 83704-7184
(208) 376-8337
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP732
ID
Other
Enumeration date
05/23/2007
Last updated
06/28/2012
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