Healthcare Provider Details

I. General information

NPI: 1699833269
Provider Name (Legal Business Name): DONNA J FOORD P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N DIVISION AVE
SANDPOINT ID
83864-8268
US

IV. Provider business mailing address

1301 N. DIVISION AVE
SANDPOINT ID
83856-8664
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-1345
  • Fax: 208-255-5531
Mailing address:
  • Phone: 208-263-1345
  • Fax: 208-255-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-156
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: