Healthcare Provider Details

I. General information

NPI: 1831762566
Provider Name (Legal Business Name): CHLOE GUMM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE COTO

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-5700
  • Fax: 208-625-5708
Mailing address:
  • Phone: 208-625-5700
  • Fax: 208-625-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60238
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7181032
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: