Provider Demographics
NPI:1669436168
Name:KRAWTZ, DIANA B (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:B
Last Name:KRAWTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POCATELLO FAMILY MEDICINE
Mailing Address - Street 2:465 MEMORIAL DRIVE
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-4711
Mailing Address - Fax:
Practice Address - Street 1:POCATELLO FAMILY MEDICINE
Practice Address - Street 2:465 MEMORIAL DRIVE
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-4711
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily