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General NPI Number Information
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NPI Number | 1225847643
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Entity Type | Organization
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Legal Business Name | AVIVA NORTHWEST, PLLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 301 N 1ST ST APT 416
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2845
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Country | US
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Telephone | 509-688-6023
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Fax | 509-231-7045
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Provider Business Mailing Address
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Address Line | 301 N 1ST ST APT 416
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2845
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Country | US
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Telephone | 509-868-6023
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Fax | 509-231-7045
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER TAYLOR
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Credential | DPH
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Telephone | 509-385-1290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number |
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License Number State |
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