Provider Demographics
NPI:1538324389
Name:LIEBENTHAL, KRISTINA LEEANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LEEANN
Last Name:LIEBENTHAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:LEEANN
Other - Last Name:UNTERSEHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-385-3230
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-385-3230
Practice Address - Fax:208-385-4088
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID869-A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily