Provider Demographics
NPI:1417339110
Name:ENRIQUEZ, LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 E FRANKLIN RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2914
Mailing Address - Country:US
Mailing Address - Phone:208-452-2672
Mailing Address - Fax:208-452-2673
Practice Address - Street 1:660 E FRANKLIN RD STE 140
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2914
Practice Address - Country:US
Practice Address - Phone:208-452-2672
Practice Address - Fax:208-452-2673
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10001014363LF0000X
NVAPRN002049363LF0000X
ID72027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10001014OtherLICENSE NUMBER
NVAPRN002049Medicaid
NVTAPRN701175OtherLICENSE NUMBER
ID72027Medicaid