Healthcare Provider Details

I. General information

NPI: 1740233345
Provider Name (Legal Business Name): MARGARET A WASSERMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 GOVERNMENT WAY
COEUR D ALENE ID
83814
US

IV. Provider business mailing address

2022 GOVERNMENT WAY
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-5536
  • Fax:
Mailing address:
  • Phone: 208-667-5536
  • Fax: 208-765-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP269A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberN14618
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: