Provider Demographics
NPI:1568459816
Name:HUGHES, LAINE DEAN (NP)
Entity Type:Individual
Prefix:MR
First Name:LAINE
Middle Name:DEAN
Last Name:HUGHES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W. IRONWOOD DRIVE, SUITE 302
Mailing Address - Street 2:LAKESIDE PEDIATRIC AND ADOLESCENT MEDICINE,
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-9998
Mailing Address - Country:US
Mailing Address - Phone:208-292-5437
Mailing Address - Fax:208-292-5441
Practice Address - Street 1:980 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-9998
Practice Address - Country:US
Practice Address - Phone:208-292-5437
Practice Address - Fax:208-292-5437
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006354363LF0000X
IDNP585A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806503200Medicaid
S93327Medicare UPIN
ID806503200Medicaid