Individual
MRS. LYNNETTE MICHELLE KHANDAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-NP
Contact information
Practice address
10112 W OVERLAND RD, BOISE, ID 83709-1428
(087) 803-9002
(208) 375-2882
Mailing address
10112 W OVERLAND RD, BOISE, ID 83709-1428
(208) 780-3900
(208) 375-2882
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN201537
AZ
363L00000X
Nurse Practitioner
NP60046
ID
363LA2200X
Adult Health Nurse Practitioner
60046
ID
363LG0600X
Gerontology Nurse Practitioner
60046
ID
363LP2300X
Primary Care Nurse Practitioner
Primary
60046
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477920270
—
ID
Enumeration date
09/07/2016
Last updated
07/16/2021
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