Provider Demographics
NPI:1417498247
Name:DETAR, FRANCIS (FNP)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:DETAR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6795 N MINERAL DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8700
Mailing Address - Country:US
Mailing Address - Phone:208-620-5250
Mailing Address - Fax:208-667-6547
Practice Address - Street 1:6795 N MINERAL DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8700
Practice Address - Country:US
Practice Address - Phone:208-620-5250
Practice Address - Fax:208-667-6547
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily