Individual
MS. CRISSIE LYNNE BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
312 3RD ST S, NAMPA, ID 83651-3717
(208) 465-7121
Mailing address
312 3RD ST S, NAMPA, ID 83651-3717
(208) 465-7121
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1474A
ID
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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