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Individual

DR. LYDIA MARIE MOOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
300 E JEFFERSON ST STE 101, BOISE, ID 83712-6221
(208) 322-1680
(208) 322-1695
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
250264
AZ
363LA2100X
Acute Care Nurse Practitioner
Primary
66852
ID

Other

Enumeration date
02/08/2021
Last updated
10/23/2023
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