Provider Demographics
NPI:1609107176
Name:ASHER, LACIE SHILO (FNP-C)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:SHILO
Last Name:ASHER
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 1:2311 PARK AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2170
Mailing Address - Country:US
Mailing Address - Phone:208-878-6413
Mailing Address - Fax:208-878-6417
Practice Address - Street 1:2311 PARKE AVE
Practice Address - Street 2:UNIT 2 SUITE 6&8
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2170
Practice Address - Country:US
Practice Address - Phone:208-878-6413
Practice Address - Fax:208-878-6417
Is Sole Proprietor?:No
Enumeration Date:2010-01-23
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-944A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1609107176Medicaid