Healthcare Provider Details

I. General information

NPI: 1487232682
Provider Name (Legal Business Name): ERIC MARTIN LADWIG NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2290 W PRAIRIE AVE
COEUR D ALENE ID
83815-8424
US

IV. Provider business mailing address

4003 S BATES RD
SPOKANE VALLEY WA
99206-6075
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-7994
  • Fax: 208-772-5916
Mailing address:
  • Phone: 208-705-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number67626
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number49472
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: