Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | M0173 | TX |
N | 2080P0210X | Pediatric Nephrologist | E-5176 | AR |
Y | 2080P0210X | Pediatric Nephrologist | M-13200 | ID |
N | 2080P0210X | Pediatric Nephrologist | M0173 | TX |
NPI | 1164476131 |
---|---|
Provider Name | Karen M Redwine |
First Address | Boise, ID 83712-6273 |
Second Address | Boise, ID 83712-6273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 03/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164436001 | (05) | AR |
180864401 | (05) | TX |
180864402 | CSHCN (01) | TX |
8P2608 | BCBSTX (01) | TX |
I54285 | (02) |