Provider Demographics
NPI:1306387329
Name:CABLIK, ELIZABETH (NP,)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:CABLIK
Suffix:
Gender:F
Credentials:NP,
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP,
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-3100
Mailing Address - Fax:208-302-3155
Practice Address - Street 1:1075 N CURTIS RD, SUITE 300
Practice Address - Street 2:SAMG COUGHLIN CLINIC BOISE
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1300
Practice Address - Country:US
Practice Address - Phone:208-302-3100
Practice Address - Fax:208-302-3155
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54782363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily