Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M9191 | ID |
NPI | 1003840034 |
---|---|
Provider Name | Lorene H Lindley |
First Address | Post Falls, ID 83877-1414 |
Second Address | Rathdrum, ID 83858-6038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 11/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807019500 | (05) | ID |
F20350 | (02) |