Provider Demographics
NPI:1023769882
Name:WENDEL, LINDSEY RAE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:WENDEL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:RAE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6231
Practice Address - Country:US
Practice Address - Phone:208-381-7011
Practice Address - Fax:208-381-9013
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997212-NP363LP0200X
CO0997212363LP0200X
ID3771451363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics