Provider Demographics
NPI:1215961990
Name:MCLAUGHLIN, PATRICIA RAIKES (CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RAIKES
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N 2ND AVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1552
Mailing Address - Country:US
Mailing Address - Phone:208-263-2173
Mailing Address - Fax:208-263-7441
Practice Address - Street 1:420 N 2ND AVE SUITE 200
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1552
Practice Address - Country:US
Practice Address - Phone:208-263-2173
Practice Address - Fax:208-263-7441
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN17955363LW0102X
IDNP204A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004377100Medicaid
ID004377100Medicaid
ID1341746Medicare ID - Type Unspecified