Healthcare Provider Details

I. General information

NPI: 1154280451
Provider Name (Legal Business Name): RACHEL ANN GOLOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E INDIANA AVE
COEUR D ALENE ID
83814-2989
US

IV. Provider business mailing address

1201 W GROVE ST APT 308
BOISE ID
83702-7409
US

V. Phone/Fax

Practice location:
  • Phone: 208-964-9023
  • Fax:
Mailing address:
  • Phone: 208-964-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4081202
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-40917
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: