Provider Demographics
NPI:1851624282
Name:DIRMANN, CARLA D (NP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:D
Last Name:DIRMANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1673 W SHORELINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6749
Mailing Address - Country:US
Mailing Address - Phone:208-593-3054
Mailing Address - Fax:208-215-3764
Practice Address - Street 1:1673 W SHORELINE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6749
Practice Address - Country:US
Practice Address - Phone:208-593-3054
Practice Address - Fax:208-215-3764
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1264A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily