Provider Demographics
NPI:1568061398
Name:EBERLINE, NICOLETTE A (DNP-FNP)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:A
Last Name:EBERLINE
Suffix:
Gender:F
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 W GUARD ST BLDG 669
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-8049
Mailing Address - Country:US
Mailing Address - Phone:208-603-4486
Mailing Address - Fax:208-218-6854
Practice Address - Street 1:4228 W GUARD ST BLDG 669
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-8049
Practice Address - Country:US
Practice Address - Phone:208-272-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily