Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
FAMILY PRACTICE BY THE LAKE LLC
Active
Organization
FAMILY PRACTICE BY THE LAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE LEE WAGNER FNP (OWNER)
(208) 661-1181
Entity
Organization
Contact information
Practice address
1875 N LAKEWOOD DR STE 205, COEUR D ALENE, ID 83814-4928
(208) 966-4087
(208) 966-4031
Mailing address
1875 N LAKEWOOD DR STE 205, COEUR D ALENE, ID 83814-4928
(208) 966-4087
(208) 966-4031
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/12/2016
Last updated
03/25/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers