Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Vadim P Pustynovich, FNP-C

Individual provider Family Nurse Practitioner · NPI 1518507086

Vadim P Pustynovich, FNP-C is a Nurse Practitioner in Coeur D Alene, Idaho. Qualified in 2019, 7 years ago. Practices with Kootenai Urgent Care LLC, an 18-clinician group and accepts Medicare assignment. Licensed in Idaho and New Jersey.

Years since qualifying
7
Licensed in
ID, NJ
In the registry since
2020
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

700 W Ironwood Dr Ste 120
Coeur D Alene, ID 83814-4405
Phone: (208) 625-3640
Fax: (208) 625-3645
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence NP66228 (ID)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 26NJ01002700 (NJ)

Record details

NPI number1518507086
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedJanuary 13, 2020
Last updated in NPPESApril 24, 2024
Certification dateApril 24, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Kootenai Urgent Care Llc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Coeur D Alene