Provider Demographics
NPI:1346608999
Name:CHATBURN, LYNDSIE
Entity Type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:
Last Name:CHATBURN
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 1:1309 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2676
Mailing Address - Country:US
Mailing Address - Phone:208-678-7796
Mailing Address - Fax:208-678-7799
Practice Address - Street 1:1309 BENNETT AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2676
Practice Address - Country:US
Practice Address - Phone:208-678-7796
Practice Address - Fax:208-678-7799
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1680A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1374810Medicare Oscar/Certification