Provider Demographics
NPI:1700583663
Name:YOST, LUE SHAWNTEL INEZ (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:LUE SHAWNTEL
Middle Name:INEZ
Last Name:YOST
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:SHAWNTEL
Other - Middle Name:
Other - Last Name:YOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2695
Mailing Address - Country:US
Mailing Address - Phone:208-848-8300
Mailing Address - Fax:
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2695
Practice Address - Country:US
Practice Address - Phone:208-848-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily