Healthcare Provider Details

I. General information

NPI: 1629664388
Provider Name (Legal Business Name): LINDSEY RAE SEIPP APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 17TH ST
LEWISTON ID
83501-3652
US

IV. Provider business mailing address

PO BOX 341
LEWISTON ID
83501-0341
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-8416
  • Fax:
Mailing address:
  • Phone: 208-743-8416
  • Fax: 509-751-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75980
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: