Healthcare Provider Details

I. General information

NPI: 1154965986
Provider Name (Legal Business Name): SHEENA SATOKO YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 258
COEUR D ALENE ID
83814-4400
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 208-625-5084
  • Fax:
Mailing address:
  • Phone: 86-255-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number630087
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: