Individual
LYDIA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7111
(208) 828-7902
Mailing address
90 HOPE DRVE, BLDG 6000, MOUNTAIN HOME, ID 83648
(208) 828-7200
(208) 828-1046
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
28164518A
IN
363LW0102X
Women's Health Nurse Practitioner
Primary
9873492-4405
UT
Other
Enumeration date
04/13/2016
Last updated
05/16/2025
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