Katrina P Mittleider, PN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

68740 Issued in ID

Practice address

500 W Fort St
Boise, ID 83702-4501

Phone

(208) 982-8732

NPI assigned

Oct 11, 2022

Last updated

Oct 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Advanced Practice Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1487379442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024501",
            "telephone_number": "208-982-8732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTLEIDER",
        "first_name": "KATRINA",
        "middle_name": "P",
        "credential": "PN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-11",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "ID",
            "license": "68740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "katrina.mittleider@va.gov",
            "affiliation": "N",
            "address_1": "500 W Fort St",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837024501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Duncan Forrest Mitchell, LCSW
• Eloise H Mitchell
• Gregory D Mitchell, M.A, L.A.T., A.T.C.
• Sam Mitchell, D.C.
• Manisha Mittal, MD
• Taylor L. Mitzel
• Yukiko Miura, M.D.
• Jesse William Mix, DO
• Tina Miyake
• Stuart Miyasako, MD

• Licensed Practical Nurse in Boise, ID
• Providers in Boise, ID by specialty
• Licensed Practical Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.