Provider Demographics
NPI:1851648059
Name:BEHRENS, JOSHUA M
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 IRONWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2670
Mailing Address - Country:US
Mailing Address - Phone:208-292-0358
Mailing Address - Fax:208-620-3991
Practice Address - Street 1:2201 IRONWOOD PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-292-0358
Practice Address - Fax:208-620-3991
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker