Provider Demographics
NPI:1770951865
Name:DOODA, NICOLE BRIANA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRIANA
Last Name:DOODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24317 E PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9677
Mailing Address - Country:US
Mailing Address - Phone:928-713-4933
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 158
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4404
Practice Address - Country:US
Practice Address - Phone:208-625-5100
Practice Address - Fax:208-625-5101
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP81891835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care