Provider Demographics
NPI:1972919447
Name:GOLLA, APRIL (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:GOLLA
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 6TH STREET
Mailing Address - Street 2:ATTN: PHYSICIAN SERVICES
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2434
Mailing Address - Country:US
Mailing Address - Phone:208-750-7462
Mailing Address - Fax:208-750-7467
Practice Address - Street 1:307 SAINT JOHNS WAY STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-743-3998
Practice Address - Fax:208-746-4879
Is Sole Proprietor?:No
Enumeration Date:2014-07-06
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60464972363LF0000X
IDNP-1443A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily