Provider Demographics
NPI:1245817220
Name:BROESCH, CHARLOTTE RENE (ARNP-CNP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:RENE
Last Name:BROESCH
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
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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:208-625-5250
Mailing Address - Fax:208-625-5251
Practice Address - Street 1:700 W IRONWOOD DR STE 350
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4487
Practice Address - Country:US
Practice Address - Phone:208-625-5230
Practice Address - Fax:208-625-5231
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID67753363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health