Healthcare Provider Details

I. General information

NPI: 1710875406
Provider Name (Legal Business Name): RACHEL ELAINE BAGLEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W PARK PL
COEUR D ALENE ID
83814-2785
US

IV. Provider business mailing address

812 NW 132ND ST APT C
VANCOUVER WA
98685-1914
US

V. Phone/Fax

Practice location:
  • Phone: 208-620-5250
  • Fax:
Mailing address:
  • Phone: 509-881-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9771061
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60652986
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: