Provider Demographics
NPI:1891116653
Name:OSIPCHUK, ALLA (APRN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:OSIPCHUK
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 W SHORELINE DR STE 140
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:208-342-9800
Mailing Address - Fax:208-342-4223
Practice Address - Street 1:633 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4510
Practice Address - Country:US
Practice Address - Phone:208-342-9800
Practice Address - Fax:208-342-4223
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-71A364SA2200X
IDN-37736163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCS34304OtherPRACTITIONER CONTROLLED SUBSTANCE
IDMO3095139OtherCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE