Provider Demographics
NPI:1841618501
Name:PARQUETTE, NICOLE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PARQUETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9321 N GOVERNMENT WAY STE E
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8263
Mailing Address - Country:US
Mailing Address - Phone:208-502-2744
Mailing Address - Fax:208-635-0135
Practice Address - Street 1:9321 N GOVERNMENT WAY STE E
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8263
Practice Address - Country:US
Practice Address - Phone:208-502-2744
Practice Address - Fax:208-635-0135
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8636NHOtherBCBS
TX8635NHOtherBCBS