Provider Demographics
NPI:1720194954
Name:EDINGER, LAURIE SUSANNE (FNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:SUSANNE
Last Name:EDINGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:S
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:8554 BENEWAH CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-9367
Mailing Address - Country:US
Mailing Address - Phone:208-610-6213
Mailing Address - Fax:
Practice Address - Street 1:502 E AMENDE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:WA
Practice Address - Zip Code:99159-7003
Practice Address - Country:US
Practice Address - Phone:999-999-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007043363L00000X
OR363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMS1273060OtherDEA