Healthcare Provider Details

I. General information

NPI: 1720194954
Provider Name (Legal Business Name): LAURIE SUSANNE EDINGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE S SPENCER ARNP

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S WASHINGTON ST STE 203
MOSCOW ID
83843-3063
US

IV. Provider business mailing address

8554 BENEWAH CREEK RD
ST MARIES ID
83861-9367
US

V. Phone/Fax

Practice location:
  • Phone: 208-892-1346
  • Fax:
Mailing address:
  • Phone: 208-968-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79001
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007043
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: