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General NPI Number Information
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NPI Number | 1730925751
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Entity Type | Individual
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Provider Name | RENEE MOTTOH DNP-FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2024
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1621 N 3RD ST STE 850
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City | COEUR D ALENE
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State | ID
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Zip | 83814-3326
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Country | US
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Telephone | 208-992-4184
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 E HORSEHAVEN AVE
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City | POST FALLS
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State | ID
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Zip | 83854-6014
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6961760
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 69217
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License Number State | ID
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