Healthcare Provider Details

I. General information

NPI: 1821962671
Provider Name (Legal Business Name): NICOLE NYQUEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

IV. Provider business mailing address

2101 N LAKEWOOD DR STE 222
COEUR D ALENE ID
83814-2473
US

V. Phone/Fax

Practice location:
  • Phone: 208-274-3320
  • Fax:
Mailing address:
  • Phone: 208-274-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8971785
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: