Individual
LINDSEY M PRUYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
630 N ARROWLEAF TRL, SISTERS, OR 97759-2610
(541) 549-1318
(541) 588-6002
Mailing address
PO BOX 1647, IDAHO FALLS, ID 83403-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-462
ID
363AM0700X
Medical Physician Assistant
Primary
PA462
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80708500
—
ID
01
—
PAUZ8
BLUE CROSS
ID
Enumeration date
01/18/2006
Last updated
07/01/2022
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