Provider Demographics
NPI:1790739951
Name:KOSTER, ANNE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:KOSTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3340 EAST GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:3025 WEST CHERRY LANE
Practice Address - Street 2:SUITE B
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8531
Practice Address - Country:US
Practice Address - Phone:208-367-8550
Practice Address - Fax:208-367-8555
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1816363LF0000X
IDNP-803A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ874174Medicaid
AZQ22123Medicare UPIN
AZ82830Medicare ID - Type Unspecified