Provider Demographics
NPI:1265489892
Name:KEIBLER, CONNIE (ARNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:KEIBLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:KEIBLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5250
Mailing Address - Fax:208-625-5251
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:STE 320
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-625-5250
Practice Address - Fax:208-625-5251
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP54219363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB25877Medicare PIN
P46109Medicare UPIN
WA9634684Medicaid
500022670OtherRAILROAD MEDICARE
WAAP30005965OtherSTATE LICENSE NUMBER