Provider Demographics
NPI:1336784081
Name:NETTLETON, ROBIN AMBER (NP-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:AMBER
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7056 W ROCKING Y LN
Mailing Address - Street 2:
Mailing Address - City:GLENNS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83623-5029
Mailing Address - Country:US
Mailing Address - Phone:218-838-0972
Mailing Address - Fax:
Practice Address - Street 1:840 N 4TH E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2166
Practice Address - Country:US
Practice Address - Phone:208-587-1850
Practice Address - Fax:208-587-1851
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID63043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily