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General NPI Number Information
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NPI Number | 1649162769
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Entity Type | Individual
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Provider Name | LYDIA LORRAINE MYERS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 2290 W PRAIRIE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8424
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Country | US
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Telephone | 208-772-7994
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Fax |
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Provider Business Mailing Address
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Address Line | 15247 N VERA ST
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City | RATHDRUM
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State | ID
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Zip | 83858-8357
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 61711
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5871066
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License Number State | ID
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