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General NPI Number Information
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NPI Number | 1205480688
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Entity Type | Individual
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Provider Name | NICKOLE DAWN COREY PMHNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 1203 IDAHO ST
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City | LEWISTON
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State | ID
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Zip | 83501-1940
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Country | US
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Telephone | 509-444-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 731 N IRON BRIDGE WAY
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City | SPOKANE
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State | WA
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Zip | 99202-4926
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Country | US
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Telephone | 509-444-8888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5371398
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License Number State | ID
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