Provider Demographics
NPI:1003412313
Name:LYNN, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1173
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1173
Mailing Address - Country:US
Mailing Address - Phone:208-261-2411
Mailing Address - Fax:866-291-4766
Practice Address - Street 1:1801 N 3RD ST STE 12
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3400
Practice Address - Country:US
Practice Address - Phone:208-261-2411
Practice Address - Fax:866-291-4766
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11142452-4405363LP0808X
WAAP61130526363LP0808X
MTAPRN-179639363LP0808X
FLAPRN11018058363LP0808X
TX1071419363LP0808X
ID70114363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health