Individual
CHARLOTTE S AINGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
156 N. 6TH ST, POTLATCH, ID 83855
(208) 875-2380
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3046
(208) 882-4511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA449
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149468
REGENCE BS OF ID
ID
01
—
0195084
DEPT OF LABOR & INDUSTRY
WA
05
—
806474000
—
ID
05
—
8325052
—
WA
01
—
PAUS3
BLUE CROSS OF ID
ID
Enumeration date
09/30/2005
Last updated
04/16/2019
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