Healthcare Provider Details

I. General information

NPI: 1518524941
Provider Name (Legal Business Name): NICHOLE JANINE BUYNAK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE BOYD

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N MINERAL DR STE 110
COEUR D ALENE ID
83815-7763
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-619-8250
  • Fax: 208-981-9201
Mailing address:
  • Phone: 208-262-2300
  • Fax: 208-262-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberO-1623
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: