Provider Demographics
NPI:1851328504
Name:DOEDYNS, CAROLYN S (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:DOEDYNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:DOEDYNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:625 POLE LINE RD W STE 2A
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4270
Practice Address - Country:US
Practice Address - Phone:208-814-8740
Practice Address - Fax:208-814-8955
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1487A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274089Medicaid
ORP53729Medicare UPIN
ORR154777Medicare PIN