Provider Demographics
NPI:1871945279
Name:ANSTRAND, CARRIE R (RN, IBCLC, LCC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:R
Last Name:ANSTRAND
Suffix:
Gender:F
Credentials:RN, IBCLC, LCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5989
Mailing Address - Country:US
Mailing Address - Phone:208-343-2074
Mailing Address - Fax:208-343-6828
Practice Address - Street 1:207 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5989
Practice Address - Country:US
Practice Address - Phone:208-343-2074
Practice Address - Fax:208-343-6828
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID29467163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant