1417339110 NPI number — LINDSEY ENRIQUEZ APRN

Table of content: LINDSEY ENRIQUEZ APRN (NPI 1417339110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417339110 NPI number — LINDSEY ENRIQUEZ APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENRIQUEZ
Provider First Name:
LINDSEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417339110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83680-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-321-5073
Provider Business Mailing Address Fax Number:
208-376-0269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 1176
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83680-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-321-5073
Provider Business Practice Location Address Fax Number:
208-376-0269
Provider Enumeration Date:
06/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN002049 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 10001014 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 72027 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TAPRN701175 . This is a "LICENSE NUMBER" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: APRN002049 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72027 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10001014 . This is a "LICENSE NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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