Organization
EVERGREEN DERMATOPATHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHLEY ANNE HAMSTRA MD (OWNER)
(208) 277-9704
Entity
Organization
Contact information
Practice address
421 E LAKESIDE AVE STE 105, COEUR D ALENE, ID 83814-2848
(208) 277-9704
(208) 277-9704
Mailing address
2151 N MAIN ST STE 248, COEUR D ALENE, ID 83814-5773
(843) 822-5550
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0900X
Dermatopathology Physician
Primary
—
—
Other
Enumeration date
04/25/2019
Last updated
09/06/2019
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