Provider Demographics
NPI:1437405966
Name:SWEENEY-AMOREBIETA, KATIE M (NP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:SWEENEY-AMOREBIETA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1555 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1786
Mailing Address - Country:US
Mailing Address - Phone:208-597-7910
Mailing Address - Fax:208-597-7909
Practice Address - Street 1:1555 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1786
Practice Address - Country:US
Practice Address - Phone:208-597-7910
Practice Address - Fax:208-597-7909
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1211A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP-1211AOtherIDAHO STATE LICENSE