Provider Demographics
NPI:1467720268
Name:BARROSO, LINDSEY (RN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BARROSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:NOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3402 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6932
Mailing Address - Country:US
Mailing Address - Phone:208-459-0092
Mailing Address - Fax:208-454-7714
Practice Address - Street 1:3402 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6932
Practice Address - Country:US
Practice Address - Phone:208-459-0092
Practice Address - Fax:208-454-7714
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-42847163W00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010027633OtherBLUESHIELD
IDHW298OtherBLUE CROSS OF IDAHO