Basic Information
| Provider Information | |||||||||
| NPI: | 1437598059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRASOVICH | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.S., RN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 E BANNOCK ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837126241 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3101 E STATE ST STE 2120 | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084733275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0121363 | CO | N | Nursing Service Providers | Registered Nurse | 363L00000X | N-50902-NP-1629A | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | NP-1629A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.