Healthcare Provider Details

I. General information

NPI: 1073785945
Provider Name (Legal Business Name): LAUREN CONSTANCE ANDERSON-CARRIERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN CONSTANCE ANDERSON DE MORENO M.D.

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 POPLAR ST
BLACKFOOT ID
83221-1758
US

IV. Provider business mailing address

98 POPLAR ST
BLACKFOOT ID
83221-1758
US

V. Phone/Fax

Practice location:
  • Phone: 208-785-3800
  • Fax: 208-785-3876
Mailing address:
  • Phone: 208-785-4100
  • Fax: 208-782-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM-17458
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: