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EVERGREEN DERMATOPATHOLOGY LLC NPI 1174187165


NPI Information

NPI: 1174187165
Provider Name: EVERGREEN DERMATOPATHOLOGY LLC
Classification: Dermatology - 207ND0900X
Entity Type: Organization

Specialization: Dermatopathology

Address:
421 E LAKESIDE AVE STE 105
COEUR D ALENE, ID
ZIP 83814
Phone: (208) 277-9704
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EVERGREEN DERMATOPATHOLOGY LLC is a dermatopathology dermatology in Coeur D Alene, ID. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. EVERGREEN DERMATOPATHOLOGY LLC NPI is 1174187165. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

421 E LAKESIDE AVE STE 105
COEUR D ALENE, ID
ZIP 83814-848
Phone: (208) 277-9704
Fax: (208) 277-9704

The provider's authorized official is Ashley Anne Hamstra .
The authorized official title is Owner and has the following contact phone number (208) 277-9704.

The enumeration date for this NPI number is 4/25/2019 and was last updated on 9/6/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyNo
2207ND0900XDermatologyDermatopathologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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