Healthcare Provider Details

I. General information

NPI: 1154072825
Provider Name (Legal Business Name): REBECCA MARIE MEYER APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA HOERMAN

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 N SCHREIBER WAY UNIT 101
COEUR D ALENE ID
83815-8434
US

IV. Provider business mailing address

3815 N SCHREIBER WAY UNIT 101
COEUR D ALENE ID
83815-8434
US

V. Phone/Fax

Practice location:
  • Phone: 208-755-2804
  • Fax: 208-765-0277
Mailing address:
  • Phone: 208-755-2804
  • Fax: 208-765-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9271448
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9271448
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: