Provider Demographics
NPI:1437103009
Name:BASSLER, HOLLY J (DO)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:BASSLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5085
Mailing Address - Fax:208-625-5731
Practice Address - Street 1:1300 E MULLAN AVE
Practice Address - Street 2:STE 1300
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6052
Practice Address - Country:US
Practice Address - Phone:208-625-5630
Practice Address - Fax:208-625-5631
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0996207Q00000X
WAOP000020872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI53314Medicare UPIN
WA8454977Medicaid
WA8874453Medicare PIN