Provider Demographics
NPI:1003403338
Name:CNOSSEN, KATHRYN LAURA (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LAURA
Last Name:CNOSSEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LAURA
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 S FEDERAL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8000 S FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-9632
Practice Address - Country:US
Practice Address - Phone:208-368-2109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily