Healthcare Provider Details

I. General information

NPI: 1467720268
Provider Name (Legal Business Name): LINDSEY BARROSO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDSEY NOE R.N.

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 FRANKLIN RD
CALDWELL ID
83605-6932
US

IV. Provider business mailing address

3402 FRANKLIN RD
CALDWELL ID
83605-6932
US

V. Phone/Fax

Practice location:
  • Phone: 208-459-0092
  • Fax: 208-454-7714
Mailing address:
  • Phone: 208-459-0092
  • Fax: 208-454-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN-42847
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberN-42847
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: