Basic Information
| Provider Information | |||||||||
| NPI: | 1760893945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RESILIENCE PSYCHIATRIC MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3727 | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838162529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082922188 | ||||||||
| FaxNumber: | 2082922189 | ||||||||
| Practice Location | |||||||||
| Address1: | 2426 N MERRITT CREEK LOOP STE A | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086687000 | ||||||||
| FaxNumber: | 2086659879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2014 | ||||||||
| LastUpdateDate: | 12/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | CARLBERG | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2082922218 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 12/23/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.