Provider Demographics
NPI:1770730392
Name:FURR, CORALYN MARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:CORALYN
Middle Name:MARIE
Last Name:FURR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CORALYN
Other - Middle Name:
Other - Last Name:BALCUNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1803
Mailing Address - Country:US
Mailing Address - Phone:208-245-5551
Mailing Address - Fax:208-245-2262
Practice Address - Street 1:229 S 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1803
Practice Address - Country:US
Practice Address - Phone:208-245-7079
Practice Address - Fax:208-245-5246
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID78102363L00000X, 363LF0000X, 363L00000X
TXAP116963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid