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NPI Code Detail

MEDICARE: LYDIA LORRAINE MYERS FNP-BC

MEDICARE: LYDIA LORRAINE MYERS FNP-BC
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
1163W00000XRegistered Nurse61711ID
2363LF0000XFamily Nurse Practitioner5871066ID

General Provider Information

NPI Number : 1649162769
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA LORRAINE MYERS FNP-BC
Provider Business Mailing Address
First Line : 15247 N VERA ST
Second Line :
City : RATHDRUM
State : ID
Zip : 83858-8357
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2290 W PRAIRIE AVE
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83815-8424
Country : US
Telephone Number : 208-772-7994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2025
Last Update Date : 08/19/2025

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