Provider Demographics
NPI:1003840034
Name:LINDLEY, LORENE H (MD)
Entity Type:Individual
Prefix:
First Name:LORENE
Middle Name:H
Last Name:LINDLEY
Suffix:
Gender:F
Credentials:MD
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 1414
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-1414
Mailing Address - Country:US
Mailing Address - Phone:208-664-8818
Mailing Address - Fax:208-664-4427
Practice Address - Street 1:13859 N REFLECTION RD
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-6038
Practice Address - Country:US
Practice Address - Phone:208-664-8818
Practice Address - Fax:208-664-4427
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807019500Medicaid
ID807019500Medicaid
F20350Medicare UPIN