Graduated: 2007
NPI: 1922268325
Practice Locations (3)
ACTIVENW LLC
305 N 3RD ST
Coeur D Alene, ID 838142861
ACTIVENW LLC
301 N 3RD ST
COEUR D ALENE, ID 838142861
2082152210
ACTIVENW LLC
305 N 3RD ST
COEUR D ALENE, ID 838142861
Source: CMS National Downloadable File, September 2026.