Healthcare Provider Details

I. General information

NPI: 1942944566
Provider Name (Legal Business Name): MELISSA COSSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

IV. Provider business mailing address

520 N 3RD AVE
SANDPOINT ID
83864-1507
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1441
  • Fax:
Mailing address:
  • Phone: 208-263-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5771446
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: