Organization · NPI-2

Active Family Healthcare PLLC

Family Medicine · Coeur D Alene, ID

NPI number1063764462
StatusActive
Last updated in NPPESMar 3, 2025

Details

NPI
1063764462
Entity type
Organization (NPI-2)
Legal business name
Active Family Healthcare PLLC
Organization subpart
No
Enumeration date
Oct 9, 2012
Certification date
Mar 3, 2025
Last updated
Mar 3, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

919 W Canfield Ave
Coeur D Alene, ID 83815-9764

Phone 208-758-0560 · Fax 208-762-5424

Mailing address

919 W Canfield Ave
Coeur D Alene, ID 83815-9764

Phone 208-758-0560 · Fax 208-762-5424

Authorized official

Jennifer Fletcher
Owner Nurse Practioner
2087580560

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