Healthcare Provider Details

I. General information

NPI: 1083534143
Provider Name (Legal Business Name): LAUREN ABIGAIL SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6348 W EMERALD ST
BOISE ID
83704-8732
US

IV. Provider business mailing address

225 S LINDER RD APT C302
EAGLE ID
83616-4431
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-0900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number8861375
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: