Healthcare Provider Details

I. General information

NPI: 1184592503
Provider Name (Legal Business Name): LALANNI BURNELL CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 CURLEW DR STE 7
AMMON ID
83406-4719
US

IV. Provider business mailing address

PO BOX 2106
IDAHO FALLS ID
83403-2106
US

V. Phone/Fax

Practice location:
  • Phone: 208-497-0898
  • Fax: 208-497-0711
Mailing address:
  • Phone: 208-523-5319
  • Fax: 208-523-5627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: