Healthcare Provider Details

I. General information

NPI: 1003248113
Provider Name (Legal Business Name): NICOLE M ENGLEDOW ARPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 02/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 8TH AVE
LEWISTON ID
83501-2691
US

IV. Provider business mailing address

1012 S. 3RD ST
DAYTON WA
99328
US

V. Phone/Fax

Practice location:
  • Phone: 208-792-2685
  • Fax: 208-792-2882
Mailing address:
  • Phone: 509-382-2531
  • Fax: 502-382-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1307A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60454197
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60454197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: