Basic Information
| Provider Information | |||||||||
| NPI: | 1528429172 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BEMIS | ||||||||
| FirstName: | BRETT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3825 N. RAMSEY RD. APT 1204 | ||||||||
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| City: | COEUR D'ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089649075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1717 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836054802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084594641 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2016 | ||||||||
| LastUpdateDate: | 01/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA-1360 | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.