Healthcare Provider Details

I. General information

NPI: 1821551359
Provider Name (Legal Business Name): KATIE VANCLEAVE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 W PRAIRIE AVE
COEUR D ALENE ID
83815-7766
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4970
  • Fax: 208-625-4991
Mailing address:
  • Phone: 208-625-4970
  • Fax: 208-625-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberO-1803
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: