Provider Demographics
NPI:1609399104
Name:GOLKE, JOHANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:GOLKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:DANIELLE
Other - Last Name:GOLKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JOHANNA GOLKE, PA-C
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:208-625-3800
Mailing Address - Fax:208-625-3801
Practice Address - Street 1:2236 N MERRITT CREEK LOOP STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4960
Practice Address - Country:US
Practice Address - Phone:208-625-3800
Practice Address - Fax:208-625-3801
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA1848363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant