Individual provider · NPI-1

Crissie Lynne Bacon, FNP

Nurse Practitioner, Family · Nampa, ID

NPI number1871992776
StatusActive
Last updated in NPPESAug 15, 2014

Details

NPI
1871992776
Entity type
Individual (NPI-1)
Name
Ms. Crissie Lynne Bacon
Credential
FNP
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 15, 2014
Last updated
Aug 15, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, FamilyNP-1474AIDYes

Other names

  • Christina Lynne Bacon (Other Name)

Practice location

312 3rd St S
Nampa, ID 83651-3717

Phone 208-465-7121

Mailing address

312 3rd St S
Nampa, ID 83651-3717

Phone 208-465-7121

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Nurse Practitioner, Family providers in Nampa, ID