Provider Demographics
NPI:1811725088
Name:DOCTOR OF NURSING PRACTICE PRIMARY CARE LLC
Entity type:Organization
Organization Name:DOCTOR OF NURSING PRACTICE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAREY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:208-786-0569
Mailing Address - Street 1:1869 E SELTICE WAY # 365
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7019
Mailing Address - Country:US
Mailing Address - Phone:208-786-0569
Mailing Address - Fax:
Practice Address - Street 1:3904 E MULLAN AVE STE C
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4009
Practice Address - Country:US
Practice Address - Phone:208-786-0569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care