Individual
LORI ANN WOODBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2327 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 557-2900
(208) 557-2910
Mailing address
3450 POTOMAC WAY, IDAHO FALLS, ID 83404-4970
(208) 552-6904
(208) 552-4973
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA410
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806542700
—
ID
Enumeration date
11/07/2006
Last updated
05/31/2016
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