IndividualActive
Sergey Kashubin, NP-C
NPI 1912569351 · Primary Care Nurse Practitioner · Boise, ID
Provider details
- NPI number
- 1912569351
- Entity type
- Individual
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP-C
- Sex
- Male
- Sole proprietor
- No
- License
- 56339 (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
10583 W Lake Hazel Rd
Boise, ID 83709-6326
Phone: (208) 302-5950
Approximate (ZIP-level) locationGet directions
Mailing address
947 E Winding Creek Dr
Eagle, ID 83616-7231
Registry dates
- Enumerated
- 2019-07-06
- Last updated
- 2021-11-23
- Certified
- 2021-11-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.