# ACTIVE FAMILY HEALTHCARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063764462
- **Authorized official:** DR. JENNIFER FLETCHER NP (OWNER NURSE PRACTIONER)
- **Authorized official phone:** (208) 758-0560

## Contact information

- **Practice address:** 919 W CANFIELD AVE, COEUR D ALENE, ID 83815-9764
- **Practice address phone:** (208) 758-0560
- **Practice address fax:** (208) 762-5424
- **Mailing address:** 919 W CANFIELD AVE, COEUR D ALENE, ID 83815-9764
- **Mailing address phone:** (208) 758-0560
- **Mailing address fax:** (208) 762-5424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2012
- **Last updated:** 03/03/2025