Individual
NICOLA L MCLACHLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, 980 W IRONWOOD DRIVE SUITE 302, COEUR D ALENE, ID 83814
(208) 667-0585
(208) 667-0876
Mailing address
LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE, 980 W IRONWOOD DRIVE SUITE 302, COEUR D ALENE, ID 83814
(208) 667-0585
(208) 667-0876
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
NP628A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010144440
REGENCE BLUE SHIELD
ID
01
—
000010144441
REGENCE BLUE SHIELD
ID
05
—
1720164122
—
MT
05
—
806680100
—
ID
05
—
9645888
—
WA
05
—
NP177ID
—
AK
01
—
NPKM0
BLUE CROSS
ID
01
—
NPPS9
BLUE CROSS OF IDAHO
ID
Enumeration date
10/27/2006
Last updated
04/10/2019
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