Healthcare Provider Details

I. General information

NPI: 1164441473
Provider Name (Legal Business Name): DIANA L KOTTKEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA L KOTTKEY NP

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2023
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: 208-799-3100
  • Fax: 208-799-0349
Mailing address:
  • Phone: 208-799-3100
  • Fax: 208-799-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP152A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: