Healthcare Provider Details

I. General information

NPI: 1568845626
Provider Name (Legal Business Name): PAMELA ANAIN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N GAVIN LOOP
COEUR D ALENE ID
83815-0066
US

IV. Provider business mailing address

6565 N GAVIN LOOP
COEUR D ALENE ID
83815-0066
US

V. Phone/Fax

Practice location:
  • Phone: 303-887-7066
  • Fax:
Mailing address:
  • Phone: 303-887-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number55564
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55564
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: