Provider Demographics
NPI:1326553314
Name:KRAHN, CHRISTOPHER T
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:KRAHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3703 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6035
Mailing Address - Country:US
Mailing Address - Phone:208-424-1465
Mailing Address - Fax:
Practice Address - Street 1:3703 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6035
Practice Address - Country:US
Practice Address - Phone:208-424-1465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID246ZA2600X
246ZA2600X
ID1246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical