Provider Demographics
NPI:1740346527
Name:MLADENKA, CHRISTINE FUHRMAN (DNP, WHNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:FUHRMAN
Last Name:MLADENKA
Suffix:
Gender:F
Credentials:DNP, WHNP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MLADENKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, WHNP
Mailing Address - Street 1:PO BOX 4021
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4021
Mailing Address - Country:US
Mailing Address - Phone:208-240-4785
Mailing Address - Fax:
Practice Address - Street 1:1901 ALVIN RICKEN DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2727
Practice Address - Country:US
Practice Address - Phone:208-233-9080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-338363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health