Provider Demographics
NPI:1477094498
Name:SASSETTI-HRYCZYK, CAROLINE (CPNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SASSETTI-HRYCZYK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4880
Mailing Address - Country:US
Mailing Address - Phone:208-232-7862
Mailing Address - Fax:
Practice Address - Street 1:500 S 11TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4878
Practice Address - Country:US
Practice Address - Phone:208-232-3355
Practice Address - Fax:855-230-7350
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73856363LP0200X
GANCO-000006363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics