Provider Demographics
NPI:1841604097
Name:HANDAL, DARLEEN MICHELLE (ACNP)
Entity Type:Individual
Prefix:
First Name:DARLEEN
Middle Name:MICHELLE
Last Name:HANDAL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HANDAL
Other - Suffix:
Other - Last Name Type:Professional 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:208-262-2498
Mailing Address - Fax:208-262-7461
Practice Address - Street 1:750 N SYRINGA ST STE 190
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5275
Practice Address - Country:US
Practice Address - Phone:208-262-2328
Practice Address - Fax:208-619-5057
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP60073363L00000X
TN18667363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1841604097Medicaid