Family Medicine
FAMILY PRACTICE BY THE LAKE LLC
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1295283810 · enumerated 2016-09-12 · record updated 2024-03-25. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: JACQUELINE WAGNER FNP, Owner · (208) 661-1181
Addresses and phones
- Practice location 1875 N LAKEWOOD DR STE 205, COEUR D ALENE, ID, 83814-4928 (208) 966-4087 Fax (208) 966-4031 Google Maps Apple Maps OpenStreetMap
- Mailing address 1875 N LAKEWOOD DR STE 205, COEUR D ALENE, ID, 83814-4928 (208) 966-4087 Fax (208) 966-4031 Google Maps Apple Maps OpenStreetMap
Specialties
- Family Medicine 207Q00000X · Primary
- Nurse Practitioner 363L00000X
In this directory
Locations and evidence
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Practice location
COEUR D ALENE, ID, 838144928
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.