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
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