Provider Demographics
NPI:1720164122
Name:MCLACHLAN, NICOLA L (PNP)
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:L
Last Name:MCLACHLAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE
Mailing Address - Street 2:980 W IRONWOOD DRIVE SUITE 302
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-667-0585
Mailing Address - Fax:208-667-0876
Practice Address - Street 1:LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE
Practice Address - Street 2:980 W IRONWOOD DRIVE SUITE 302
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-667-0585
Practice Address - Fax:208-667-0876
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP628A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010144440OtherREGENCE BLUE SHIELD
AKNP177IDMedicaid
ID806680100Medicaid
MT1720164122Medicaid
WA9645888Medicaid
IDNPKM0OtherBLUE CROSS
IDNPPS9OtherBLUE CROSS OF IDAHO
ID000010144441OtherREGENCE BLUE SHIELD