Provider Demographics
NPI:1528684990
Name:MABE, ANNALISE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNALISE
Middle Name:
Last Name:MABE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNALISE
Other - Middle Name:
Other - Last Name:GOYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2199 N MERRITT CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4949
Mailing Address - Country:US
Mailing Address - Phone:208-665-7546
Mailing Address - Fax:208-667-4607
Practice Address - Street 1:2199 N MERRITT CREEK LOOP
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4949
Practice Address - Country:US
Practice Address - Phone:208-665-7546
Practice Address - Fax:208-667-4607
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant