LUCUS CRAIG WEBB CHRISTOFFERSEN


Address: 98 Poplar St, Blackfoot, ID 83221-1799
Phone: 2087854100

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).

Provider Overview

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

Taxonomy

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

Office Location

Street Address 98 POPLAR ST
City BLACKFOOT
State ID
Zip Code 83221-1799

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363LA2100X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Acute Care

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

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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Competitor

Search similar providers

City BLACKFOOT
Zip Code 83221

Improve Information

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Dataset Information

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.

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