Healthcare Provider Details

I. General information

NPI: 1659692200
Provider Name (Legal Business Name): STEPHANIE ANN HART ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN FLETCHER ARNP

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 E POLSTON AVE STE 102
POST FALLS ID
83854-2668
US

IV. Provider business mailing address

3815 N SCHREIBER WAY STE 101
COEUR D ALENE ID
83815-8362
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64956
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60158260
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number64956
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: