Healthcare Provider Details

I. General information

NPI: 1023769882
Provider Name (Legal Business Name): LINDSEY RAE WENDEL CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY RAE ELLIOTT CPNP-PC

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E JEFFERSON ST
BOISE ID
83712-6231
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7011
  • Fax: 208-381-9013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.0997212-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0997212
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3771451
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: