Provider Demographics
NPI:1346727153
Name:WINDER, DRUE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:DRUE
Middle Name:MARIE
Last Name:WINDER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DRUE
Other - Middle Name:MARIE
Other - Last Name:HENINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7733 S 8TH W
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-5896
Mailing Address - Country:US
Mailing Address - Phone:208-520-3634
Mailing Address - Fax:
Practice Address - Street 1:3320 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4606
Practice Address - Country:US
Practice Address - Phone:208-656-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58913363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics