Provider Demographics
NPI:1639282585
Name:SVANGSTU, DEBORAH N
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:N
Last Name:SVANGSTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 W CURTISIAN AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8907
Mailing Address - Country:US
Mailing Address - Phone:208-327-5600
Mailing Address - Fax:208-327-5602
Practice Address - Street 1:6140 CURTISIAN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8880
Practice Address - Country:US
Practice Address - Phone:208-327-5600
Practice Address - Fax:208-327-5602
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP762A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807587800Medicaid
WA0214273OtherWA DEPART OF LABOR
ID000010158523OtherREGENCE BLUESHIELD
IDNPYA3OtherBLUE CROSS OF IDAHO
ID807587800Medicaid
IDNPYA3OtherBLUE CROSS OF IDAHO
ID1345768Medicare PIN