Most Relevant Information
Provider Data
| NPI Number: | 1003650177 |
| Provider Name: | KAITLIN EDMINSTEN DNP, AGACNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | 74901 |
Most Important Dates
| Enumeration Date: | 06/22/2024 |
| Last Updated: | 08/05/2024 |
Provider Practice Location
190 E BANNOCK ST
BOISE
ID
837126241
Practice Location Phone/Fax
| Phone: | 2083815015 |
| Fax: | 2083811873 |
Provider Mailing Location
190 E BANNOCK ST
BOISE
ID
837126241
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |