Basic Information
| Provider Information | |||||||||
| NPI: | 1467619635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORSMAN | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOLTE | ||||||||
| OtherFirstName: | KATIE | ||||||||
| OtherMiddleName: | LEANNE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 980 W. IRONWOOD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COEUR D' ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087651455 | ||||||||
| FaxNumber: | 2086678655 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 W. IRONWOOD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COEUR D' ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087651455 | ||||||||
| FaxNumber: | 2086678655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP874A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | N32423 | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.