MEDICARE: LYNN F. SHENK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	10954	MT
2	208100000X	Physical Medicine & Rehabilitation Physician	M-17779	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0151424	OTHER	MT	MDCD PIN
2	000092646	OTHER	MT	BCBS PIN
3	122153100	OTHER	WY	MDCD PIN

General Provider Information

NPI Number	:	1134208572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN F. SHENK DO

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N ROBBINS RD STE 300
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4539
Country	:	US
Telephone Number	:	208-706-0400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2006
Last Update Date	:	07/08/2024

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