| Doctor Name: | MRS. NICOLE MARIE ENGLEDOW |
| NPI Number: | 1003248113 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | NP-1307A |
| Business Practice Address: | 500 8th Ave Lewiston, ID - 835012691 |
| Business Phone Number: | 2087922685 |
| Business Fax Number: | 2087922882 |
| Mailing Address: | 500 8th Ave, LEWISTON |
| State: | ID |
| Postal Code: | 835012691 |
| Phone Number: | 2087922685 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2013 |
| NPI Last Update Date: | 08/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP-1307A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |