Healthcare Provider Details

I. General information

NPI: 1477197036
Provider Name (Legal Business Name): MEGAN LENKERSDORFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS RD
BOISE ID
83706-1309
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-2121
  • Fax:
Mailing address:
  • Phone: 208-367-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62697
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62697
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: