Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 63300 | ID |
NPI | 1033754395 |
---|---|
Provider Name | Christine Van Orden |
First Address | Idaho Falls, ID 83404-8255 |
Second Address | Idaho Falls, ID 83404-7533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2019 |
Last Update Date | 11/03/2020 |