Provider Demographics
NPI:1467770792
Name:VENN, LINDSAY (RDLD, PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:VENN
Suffix:
Gender:F
Credentials:RDLD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4606
Mailing Address - Country:US
Mailing Address - Phone:208-656-1500
Mailing Address - Fax:
Practice Address - Street 1:3320 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-656-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-341133V00000X
IDPA-1502208000000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No208000000XAllopathic & Osteopathic PhysiciansPediatrics