Healthcare Provider Details

I. General information

NPI: 1265288773
Provider Name (Legal Business Name): KATHERINE MARIE DEMIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N SCHREIBER WAY UNIT 102
COEUR D ALENE ID
83815-8434
US

IV. Provider business mailing address

3815 N SCHREIBER WAY UNIT 102
COEUR D ALENE ID
83815-8434
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-4557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79570
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9471356
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: