Healthcare Provider Details

I. General information

NPI: 1699600163
Provider Name (Legal Business Name): AFTON M. ELAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 N DONOVAN LN
POST FALLS ID
83854-5154
US

IV. Provider business mailing address

4309 N DONOVAN LN
POST FALLS ID
83854-5154
US

V. Phone/Fax

Practice location:
  • Phone: 208-919-4571
  • Fax:
Mailing address:
  • Phone: 208-919-4571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number67950
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: