Provider Demographics
NPI:1326144932
Name:ARNOLD, LYNDA J (ARNP, CWCN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:J
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:ARNP, CWCN
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 238
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0238
Mailing Address - Country:US
Mailing Address - Phone:208-664-3301
Mailing Address - Fax:877-653-2694
Practice Address - Street 1:296 W SUNSET AVE STE 14
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8367
Practice Address - Country:US
Practice Address - Phone:208-967-4771
Practice Address - Fax:208-683-8101
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-770A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807684700Medicaid
WAG000301387OtherMEDICARE GROUP
IDP00390223OtherMEDICARE RAILROAD CARRIER
IDP00390223OtherMEDICARE RAILROAD CARRIER
WAG8866726Medicare PIN
IDQ76168Medicare UPIN