Healthcare Provider Details

I. General information

NPI: 1962815837
Provider Name (Legal Business Name): CHELSEA DICKMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LINCOLN WAY STE 415
COEUR D ALENE ID
83814-2527
US

IV. Provider business mailing address

1593 E POLSTON AVE
POST FALLS ID
83854-5326
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4595
  • Fax: 208-625-4596
Mailing address:
  • Phone: 208-262-2300
  • Fax: 208-262-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2661
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-2661
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: