Provider Demographics
NPI:1104958214
Name:GEBAUER-ATKINS, ELLOUISE (FNP)
Entity type:Individual
Prefix:
First Name:ELLOUISE
Middle Name:
Last Name:GEBAUER-ATKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 E 3800 N
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-6118
Mailing Address - Country:US
Mailing Address - Phone:208-543-4233
Mailing Address - Fax:
Practice Address - Street 1:1650 E 3800 N
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:ID
Practice Address - Zip Code:83316-6118
Practice Address - Country:US
Practice Address - Phone:208-543-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-47A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010138571OtherPROVIDER NUMBER
ID000010138571OtherPROVIDER NUMBER
IDR37130Medicare UPIN