Provider Demographics
NPI:1275105371
Name:PELE, LIA LYNNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:LYNNE
Last Name:PELE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 E GALA ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4880
Mailing Address - Country:US
Mailing Address - Phone:208-922-7982
Mailing Address - Fax:208-314-0470
Practice Address - Street 1:2320 E GALA ST STE 400
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4880
Practice Address - Country:US
Practice Address - Phone:208-922-7982
Practice Address - Fax:208-809-2881
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID68813363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner