Provider Demographics
NPI:1255653788
Name:HYDE, LISA K (RNFA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:HYDE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 E MOON DIPPER CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9138
Mailing Address - Country:US
Mailing Address - Phone:208-867-5561
Mailing Address - Fax:
Practice Address - Street 1:2917 E MOON DIPPER CT
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9138
Practice Address - Country:US
Practice Address - Phone:208-867-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-22291163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant