Provider Demographics
NPI:1821715095
Name:TAK, DEEANN BRIGGS (BSN-RN, CDCES)
Entity Type:Individual
Prefix:
First Name:DEEANN
Middle Name:BRIGGS
Last Name:TAK
Suffix:
Gender:F
Credentials:BSN-RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CHANNING WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7546
Mailing Address - Country:US
Mailing Address - Phone:208-528-2925
Mailing Address - Fax:208-528-7371
Practice Address - Street 1:3200 CHANNING WAY STE 102
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7546
Practice Address - Country:US
Practice Address - Phone:208-528-2925
Practice Address - Fax:208-528-7371
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-32403163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator