=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487232682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC MARTIN LADWIG NP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2021
-----------------------------------------------------
Last Update Date | 06/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2290 W PRAIRIE AVE
-----------------------------------------------------
City | COEUR D ALENE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83815-8424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-772-7994
-----------------------------------------------------
Fax | 208-772-5916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4003 S BATES RD
-----------------------------------------------------
City | SPOKANE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99206-6075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-705-0656
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 49472
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 67626
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------