Provider Demographics
NPI:1518141563
Name:VIETH, PATRICIA ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:VIETH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:KNOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1641 E POLSTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7852
Practice Address - Country:US
Practice Address - Phone:208-457-4208
Practice Address - Fax:208-457-4197
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-725363AS0400X, 363A00000X, 363AM0700X
WAPA60944866363AS0400X, 363A00000X, 363AM0700X
IDPA725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609909282OtherGROUP NPI
ID807958700Medicaid
16650772Medicare PIN