Individual
SERGEY KASHUBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
10583 W LAKE HAZEL RD, BOISE, ID 83709-6326
(208) 302-5950
Mailing address
947 E WINDING CREEK DR, STE 200, EAGLE, ID 83616-7231
(208) 302-5900
(208) 302-5955
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
56339
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
56339
ID
Other
Enumeration date
07/06/2019
Last updated
11/23/2021
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