Provider Demographics
NPI:1497367114
Name:RUGGLES, LINDSAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:RUGGLES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16570 N BROOKDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-4707
Mailing Address - Country:US
Mailing Address - Phone:208-550-2471
Mailing Address - Fax:
Practice Address - Street 1:1105 S FEDERAL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2546
Practice Address - Country:US
Practice Address - Phone:208-342-1129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily