Provider Demographics
NPI:1760708044
Name:KRULL, FAITH MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:MARIE
Last Name:KRULL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:MARIE
Other - Last Name:SMART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:980 W IRONWOOD DR
Practice Address - Street 2:SUITE 306
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2668
Practice Address - Country:US
Practice Address - Phone:208-625-4970
Practice Address - Fax:208-625-4991
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNM-57A176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife