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General NPI Number Information
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NPI Number | 1467770792
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Entity Type | Individual
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Provider Name | LINDSAY VENN R.D.L.D., PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 3320 S 25TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-656-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 S 25TH E
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4606
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Country | US
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Telephone | 208-656-1500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-341
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | PA-1502
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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