Healthcare Provider Details

I. General information

NPI: 1497367114
Provider Name (Legal Business Name): LINDSAY RUGGLES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 S FEDERAL WAY
BOISE ID
83705-2546
US

IV. Provider business mailing address

16570 N BROOKDALE PKWY
NAMPA ID
83687-4707
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-1129
  • Fax:
Mailing address:
  • Phone: 208-550-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number65533
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: