Provider Demographics
NPI:1770622946
Name:COONAN, NANCY M (CFA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:COONAN
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 ENSIGN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1243
Mailing Address - Country:US
Mailing Address - Phone:208-376-6841
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 104
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1339
Practice Address - Country:US
Practice Address - Phone:208-378-4749
Practice Address - Fax:208-378-7519
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00F622246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist