Healthcare Provider Details

I. General information

NPI: 1861484701
Provider Name (Legal Business Name): AMANDA L FIOLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA L FOUCAULT, FIOLA, HAHN

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 375
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 208-625-6100
  • Fax: 208-625-6101
Mailing address:
  • Phone: 208-625-5085
  • Fax: 208-625-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA538
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: