Provider Demographics
NPI:1679688030
Name:HEALING ARTS WOMEN'S CLINIC, PA
Entity Type:Organization
Organization Name:HEALING ARTS WOMEN'S CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-467-6666
Mailing Address - Street 1:222 W IOWA AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-6815
Mailing Address - Country:US
Mailing Address - Phone:208-467-6666
Mailing Address - Fax:208-467-6680
Practice Address - Street 1:222 W IOWA AVE STE 225
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6815
Practice Address - Country:US
Practice Address - Phone:208-467-6666
Practice Address - Fax:208-467-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8H815OtherBLUE CROSS OF IDAHO
IDDD0093Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OR130052Medicare ID - Type Unspecified
ID8H815OtherBLUE CROSS OF IDAHO