Individual
MR. MICHAEL LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2500 WEST A STE., STE #1, MOSCOW, ID 83843
(208) 882-0540
(208) 882-1487
Mailing address
623 SOUTH MAIN ST., STE #1, MOSCOW, ID 83843-2983
(208) 882-2011
(208) 883-1853
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
122180
CO
363LA2100X
Acute Care Nurse Practitioner
NP-941
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122180
NURSING LICENSE #
CO
01
—
NP-941
IDAHO NURSING LICENSE
ID
Enumeration date
03/06/2007
Last updated
11/13/2012
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