Healthcare Provider Details

I. General information

NPI: 1063199131
Provider Name (Legal Business Name): RAQUEL JOYE LINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W PRAIRIE AVE
COEUR D ALENE ID
83815-8780
US

IV. Provider business mailing address

18377 W PALOMAR DR
POST FALLS ID
83854-8798
US

V. Phone/Fax

Practice location:
  • Phone: 208-209-0288
  • Fax:
Mailing address:
  • Phone: 208-277-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number66350
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: