Provider Demographics
NPI:1386204758
Name:HASTRITER, AIMEE LYNN (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:HASTRITER
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E IDAHO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6225
Mailing Address - Country:US
Mailing Address - Phone:208-870-3498
Mailing Address - Fax:
Practice Address - Street 1:125 E IDAHO ST STE 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6225
Practice Address - Country:US
Practice Address - Phone:208-381-7340
Practice Address - Fax:208-381-7341
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID36372363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics