Healthcare Provider Details

I. General information

NPI: 1417732587
Provider Name (Legal Business Name): LLYN RIVERS ZILLICH DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LLYN RIVERS ALLEN

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 06/28/2023
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

1607 N GLASGOW DR
POST FALLS ID
83854-5821
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4000
  • Fax:
Mailing address:
  • Phone: 704-796-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77418
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: