| Doctor Name: | MISS NICHOELLE RENEE GOURLEY |
| NPI Number: | 1407009418 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA781 |
| Business Practice Address: | 551 Highland Dr Arco, ID - 83213 |
| Business Phone Number: | 2085278206 |
| Business Fax Number: | 2085273616 |
| Mailing Address: | Po Box 815, ARCO |
| State: | ID |
| Postal Code: | 832130815 |
| Phone Number: | 2085278206 |
| Fax Number: | 2085273616 |
| NPI Enumeration Date: | 11/04/2008 |
| NPI Last Update Date: | 11/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA781 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |