Family Practice by the Lake LLC
NPI #1295283810 in Coeur D Alene, Idaho
Provider Information
- NPI Number
- 1295283810
- Entity Type
- Organization
- Organization Name
- Family Practice by the Lake LLC
- Primary Specialty
- Family Medicine
- Enumeration Date
- Sep 12, 2016
- Last Updated
- Mar 25, 2024
Practice Location
- Address
- 1875 N LAKEWOOD DR STE 205
- City
- Coeur D Alene
- State
- Idaho
- ZIP Code
- 83814-4928
- Phone
- (208) 966-4087
Authorized Official
- Name
- JACQUELINE LEE WAGNER, FNP
- Title
- OWNER
- Phone
- (208) 661-1181
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
| Family Medicine |
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