Individual
EILEEN YOUNGBLOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-C
Contact information
Practice address
250 W BOBWHITE CT, BOISE, ID 83706-6643
(208) 426-0052
Mailing address
2126 N FIRE OPAL AVE, KUNA, ID 83634-2004
(718) 877-1770
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
67667
ID
163WG0000X
General Practice Registered Nurse
67667
ID
163WN1003X
Nutrition Support Registered Nurse
67667
ID
363LA2200X
Adult Health Nurse Practitioner
Primary
9071657
ID
363LG0600X
Gerontology Nurse Practitioner
9071657
ID
Other
Enumeration date
04/01/2024
Last updated
03/03/2025
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