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EVERGREEN DERMATOPATHOLOGY LLC
NPI 1174187165
Dermatology - Dermatopathology in Coeur D Alene, ID

Active since April 25, 2019CLIA 50D2281860 · Certificate of Compliance
421 E LAKESIDE AVE STE 105, COEUR D ALENE, ID 83814(208) 277-9704(208) 277-9704 Get Directions Write a Review

NPPES record last updated: September 6, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 6, 2019, May 3, 2019, Apr 25, 2019 (3 updates tracked since 2019).

About Evergreen Dermatopathology Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN DERMATOPATHOLOGY LLC (NPI 1174187165) is a healthcare organization registered as a dermatopathology in Coeur D Alene, Idaho and active in the NPI registry since April 2019. The organization holds a CLIA Certificate of Compliance certificate valid through April 4, 2028 and lists Ashley Anne Hamstra, Owner, as its authorized official.

NPPES Registry Identity

NPI1174187165
Entity TypeOrganization
Primary Taxonomy207ND0900X
Legal Business NameEVERGREEN DERMATOPATHOLOGY LLC
Location Address421 E LAKESIDE AVE STE 105Coeur D Alene, ID 83814-2848
Mailing Address2151 N Main St Ste 248Coeur D Alene, ID 83814-5773 · (843) 822-5550
Phone(208) 277-9704
Fax(208) 277-9704
Organization SubpartNo
Authorized OfficialAshley Anne HamstraOwner · (208) 277-9704
Enumeration DateApril 25, 2019
Last NPPES UpdateSeptember 6, 20193 updates tracked since enumeration
✔ NPI 1174187165 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · DermatopathologyAllopathic & Osteopathic Physicians
Taxonomy Code207ND0900X
Definition
A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.
Also ListedDermatologyTaxonomy 207N00000X
421 E LAKESIDE AVE STE 105, Coeur D Alene, ID 83814
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Group Practice 2

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 50D2281860

Evergreen Dermatopathology · Liberty Lake, WA
Active · expires Apr 4, 2028
CLIA Number50D2281860
Laboratory TypeIndependent
Certificate Effective DateMay 12, 2023
Certificate Expiration DateApril 4, 2028
Laboratory DirectorAshley Hamstra
Laboratory Phone(208) 277-9704
Laboratory LocationEvergreen Dermatopathology2110 N Molter Rd Ste 112, Liberty Lake, WA 99019
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Dermatopathology LLC's NPI number?

The NPI number for Evergreen Dermatopathology LLC is 1174187165. It was assigned to this organization in the NPPES registry on April 25, 2019.

Where is Evergreen Dermatopathology LLC located?

Evergreen Dermatopathology LLC is located at 421 E Lakeside Ave Ste 105, Coeur D Alene, ID 83814. The listed phone number is (208) 277-9704.

What is Evergreen Dermatopathology LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Dermatopathology, with taxonomy code 207ND0900X.

Does Evergreen Dermatopathology LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 50D2281860) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Evergreen Dermatopathology LLC was last updated on September 6, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.