Individual
VINCENT FIBELSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 743-2511
(208) 799-5554
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-02
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10017689
REGENCE OF ID URGENT CARE
ID
01
—
10017690
REGENCE OF IDAHO
ID
05
—
8118705
—
WA
01
—
HBNA1
IDAHO BLUE CROSS
ID
Enumeration date
02/02/2007
Last updated
07/09/2007
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