Healthcare Provider Details

I. General information

NPI: 1225057813
Provider Name (Legal Business Name): NORTH CENTRAL DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 10TH ST
LEWISTON ID
83501-1912
US

IV. Provider business mailing address

215 10TH ST
LEWISTON ID
83501-1912
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-0349
  • Fax:
Mailing address:
  • Phone: 208-799-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: CAROL M MOEHRLE
Title or Position: DIRECTOR
Credential: RN
Phone: 208-799-3100