NPI 1174187165

Evergreen Dermatopathology LLC

Organisation Dermatopathology Physician Coeur D Alene, ID

Practice location

Address: 421 E Lakeside Ave STE 105, Coeur D Alene, ID 83814-2848
Phone: (208) 277-9704
Fax: (208) 277-9704
Mailing address: 2151 N Main St STE 248, Coeur D Alene, ID 83814-5773

Authorised official

Name: Ashley Anne Hamstra
Title: Owner
Phone: (208) 277-9704

Registered specialties (2)

Dermatopathology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207ND0900X

Other Dermatology providers in Idaho →

Dermatology Physician

Allopathic & Osteopathic Physicians Taxonomy 207N00000X

Registry record

NPI: 1174187165
Entity type: Organization
NPI issued: 25 Apr 2019
Record last updated: 6 Sep 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.