Provider Demographics
NPI:1679567465
Name:HERBST, SUSAN E (PN MS AOCN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HERBST
Suffix:
Gender:F
Credentials:PN MS AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-666-2000
Mailing Address - Fax:208-666-3963
Practice Address - Street 1:2000 KOOTENAI HEALTH WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-666-2000
Practice Address - Fax:208-666-3963
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-10A364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806210600Medicaid
ID806210600Medicaid
ID1305046Medicare ID - Type UnspecifiedMEDICARE