Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Evergreen Dermatopathology LLC

Organization Dermatology Physician · NPI 1174187165

Evergreen Dermatopathology LLC is a Dermatology Physician in Coeur D Alene, Idaho. Registered with an NPI since 2019.

In the registry since
2019
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

421 E Lakeside Ave Ste 105
Coeur D Alene, ID 83814-2848
Phone: (208) 277-9704
Fax: (208) 277-9704
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatopathology Physician (primary) Taxonomy 207ND0900X
Dermatology Physician Taxonomy 207N00000X

Record details

NPI number1174187165
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ashley Hamstra — Owner · (208) 277-9704
NPI enumeratedApril 25, 2019
Last updated in NPPESSeptember 6, 2019
Mailing address2151 N Main St Ste 248, Coeur D Alene, ID 83814-5773

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