LUCUS CRAIG WEBB CHRISTOFFERSEN (NPI# 1629685177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1629685177 |
Entity Type | Individual |
Full Name | LUCUS CRAIG WEBB CHRISTOFFERSEN |
Credential | APRN |
Practice Address |
98 Poplar St Blackfoot ID 83221-1799 |
Mailing Address |
1554 Richland Cir Idaho Falls ID 83401-4091 |
Practice Telephone | 2087854100 |
Mailing Telephone | 2085301326 |
Enumeration Date | 2020-09-29 |
Last Update Date | 2020-10-07 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163WC0200X |
Registered Nurse Specialization: Critical Care Medicine |
60631 | ID | Nursing Service Providers |
Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
60631 | ID | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
98 POPLAR ST |
City | BLACKFOOT |
State | ID |
Zip Code | 83221-1799 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609871474 | Wade H Flowers Jr. | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2005-06-16 |
1770111924 | Kywnynn Madsen | Dietitian, Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2020-03-31 |
1235795915 | Megan Lewis | Advanced Practice Midwife | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-05-17 |
1083177935 | Jason Lee Harmon | Student in an Organized Health Care Education/Training Program | 98 Poplar St, Blackfoot, ID 83221-1758 | 2019-04-08 |
1851870091 | Jennifer L Wistisen | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1799 | 2018-08-08 |
1114405396 | Ryan Blair Killpack | Physician Assistant | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-31 |
1023504651 | Amanda Wray | Pharmacist | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-07-06 |
1699268276 | Zachary D Morrow | Nurse Anesthetist, Certified Registered | 98 Poplar St, Blackfoot, ID 83221-1758 | 2018-06-08 |
1184115107 | Megan Nicole Broyles | Pharmacist | 98 Poplar St, Blackfoot, ID 83221 | 2018-05-24 |
1295223493 | Carolyn Louise Hansen | Nurse Practitioner | 98 Poplar St, Blackfoot, ID 83221-1799 | 2018-04-24 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932711165 | Samantha Paige Averett | Social Worker | 60 N Broadway, Blackfoot, ID 83221 | 2020-08-19 |
1730711656 | Sara Marie Letham | Family Medicine | 33 S Thompson Lane, Blackfoot, ID 83221 | 2020-02-08 |
1962994962 | Tyler Thomas Wood | Student in an Organized Health Care Education/Training Program | 98 Poplar Street, Blackfoot, Id 83221, Blackfoot, ID 83221 | 2018-06-05 |
1801336276 | Bmh, Inc. | Internal Medicine | 235 Poplar St, Blackfoot, ID 83221 | 2017-03-03 |
1497119804 | Susan Doran | Social Worker | 720 E. Alice, Blackfoot, ID 83221 | 2016-04-12 |
1427412121 | Josie Russell Adkins | Counselor | 720 East Alice, Blackfoot, ID 83221 | 2016-04-08 |
1740590314 | Ashley Nichole Thomas | Physician Assistant | 710 E. Alice Street, Blackfoot, ID 83221 | 2010-10-18 |
1528373313 | Stephanie Lynn Henderson | Dietitian, Registered | 1555 Vernon Ave, Blackfoot, ID 83221 | 2010-08-17 |
1184850141 | Joy H. Taylor | Nurse Practitioner | 1441 Parkway Drive, Blackfoot, ID 83221 | 2009-06-04 |
1427232925 | Nathan E. Sneddon | Anesthesiology | 98 Poplar St Fl 3, Blackfoot, ID 83221 | 2007-12-20 |
Find all providers in zip 83221 |
Taxonomy Code | 363LA2100X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Acute Care |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629685235 | Mark Mitchell Roubidoux II | Nurse Practitioner | 201 18th Ave, Lewiston, ID 83501-2768 | 2020-09-28 |
1275199663 | Jason T Elliott | Nurse Practitioner | 12094 N Barn Owl Way, Boise, ID 83714-1363 | 2019-05-12 |
1699055491 | Nicole Dawn Bartlett | Nurse Practitioner | 243 Cheney Dr W Ste 200, Twin Falls, ID 83301-4278 | 2011-08-24 |
1174707442 | Tracy K Matalon | Nurse Practitioner | 3340 E Goldstone Way, Meridian, ID 83642-1026 | 2007-12-21 |
1639364482 | Saint Alphonsus Specialty Services Inc | Nurse Practitioner | 660 E Boise Ave, Boise, ID 83706-5118 | 2007-09-13 |
1780879536 | Saint Alphonsus Specialty Services Inc | Nurse Practitioner | 2809 Cleveland Blvd, Caldwell, ID 83605-4443 | 2007-09-13 |
1962522409 | Wendy Swope | Nurse Practitioner | 3388 Highway 26, Irwin, ID 83428 | 2007-03-29 |
1609808328 | Nancy Nuce Taylor | Nurse Practitioner | 3525 E Louise Dr Ste 500, Meridian, ID 83642-6305 | 2006-07-06 |
1336193598 | Angela K. Hughes | Nurse Practitioner | 6933 W Emerald St, Boise, ID 83704-8616 | 2006-05-20 |
1174156962 | Rachel Lynne Davis | Nurse Practitioner | 190 E Bannock St, Boise, ID 83712-6241 | 2020-02-20 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.