Basic Information
| Provider Information | |||||||||
| NPI: | 1538647029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHRONISTER | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | COOMBS | ||||||||
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| Credential: | FNP-C | ||||||||
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| OtherLastName: | COOMBS | ||||||||
| OtherFirstName: | BRITTANY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 29863 FARMWAY RD | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836078679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088303270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1219 SW 4TH AVE UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201805416NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.