Organization
NURTURE LACTATION SUPPORT FOR WOMEN & INFANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIE KARROUM FNP (PROVIDER)
(208) 569-9031
Entity
Organization
Contact information
Practice address
5480 GLENEAGLES DR, IDAHO FALLS, ID 83401-6315
(208) 569-9031
Mailing address
5480 GLENEAGLES DR, IDAHO FALLS, ID 83401-6315
(208) 569-9031
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FNP57631
LICENSE
ID
Enumeration date
12/03/2018
Last updated
12/03/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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