Individual provider · NPI-1

Alexandra Bellem

Family Medicine · Coeur D Alene, ID

NPI number1639533847
StatusActive
Last updated in NPPESFeb 11, 2020

Details

NPI
1639533847
Entity type
Individual (NPI-1)
Name
Alexandra Bellem
Sex
Female
Sole proprietor
No
Enumeration date
Apr 13, 2016
Certification date
Feb 11, 2020
Last updated
Feb 11, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine14059IDYes

Practice location

1090 W Park Pl
Coeur D Alene, ID 83814-2785

Phone 208-415-0299 · Fax 208-625-2070

Mailing address

1919 Lincoln Way
Coeur D Alene, ID 83814-2527

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