Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 10367.0054 | WY |
N | 363LP2300X | Nurse Practitioner - Primary Care | 10367.0054 | WY |
NPI | 1013187236 |
---|---|
Provider Name | Mrs. Lisa E Larson Hoyt |
First Address | Idaho Falls, ID 83403-2257 |
Second Address | Jackson, WY 83001-2790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
315839 | BLUE CROSS OF WY (01) | WY |