Provider Demographics
NPI:1487633293
Name:MARICLE-KUWAHARA, LYNDA J (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:J
Last Name:MARICLE-KUWAHARA
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:J
Other - Last Name:MARICLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3852 HIGHWAY 21
Mailing Address - Street 2:P.O. BOX 554
Mailing Address - City:IDAHO CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83631-4176
Mailing Address - Country:US
Mailing Address - Phone:208-392-4544
Mailing Address - Fax:208-392-4128
Practice Address - Street 1:3852 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:IDAHO CITY
Practice Address - State:ID
Practice Address - Zip Code:83631-4176
Practice Address - Country:US
Practice Address - Phone:208-392-4544
Practice Address - Fax:208-392-4128
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP497OtherBLUE CROSS
ID1375328Medicare ID - Type Unspecified
IDNP497OtherBLUE CROSS