LIDIA TIMOFEENKO PETERSEN (NPI# 1245857952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245857952 |
| Entity Type | Individual |
| Full Name | LIDIA TIMOFEENKO PETERSEN |
| Practice Address |
775 Wayne Ave Pocatello ID 83201-3718 |
| Practice Telephone | 2084103048 |
| Mailing Telephone | 2084103048 |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2020-06-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
TEMP53260 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
775 WAYNE AVE |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-3718 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699070482 | Darrin B. Robertson | Nurse Practitioner | 161 Jefferson Ave, Pocatello, ID 83201-3921 | 2011-01-25 |
| 1851447585 | Kathleen Werner-leap | Nurse Practitioner | 427 N Arthur Ave Ste B, Pocatello, ID 83204-3006 | 2007-01-26 |
| 1114402450 | Earl John Weston | Nurse Practitioner | 1000 N 8th Ave, Pocatello, ID 83201 | 2018-10-02 |
| 1912489980 | Renee Gault | Nurse Practitioner | 444 Hospital Way Ste 477, Pocatello, ID 83201-2744 | 2018-09-05 |
| 1811369689 | Jennie Brumfield | Nurse Practitioner | 1000 N 8th Ave, Pocatello, ID 83201-5757 | 2015-10-20 |
| 1538576491 | Vernon Robert Kubiak | Nurse Practitioner | 1070 Hiline Rd, Suite 210, Pocatello, ID 83201-2947 | 2014-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790302594 | Dumu Psychiatry LLC | Nurse Practitioner | 9428 W Fairview Ave, Boise, ID 83704-8101 | 2020-06-29 |
| 1861024689 | Jessica Erin Bringman | Nurse Practitioner | 3624 23rd St, Lewiston, ID 83501-6121 | 2020-02-10 |
| 1528610532 | Shawn Warren | Nurse Practitioner | 755 Lomax St, Idaho Falls, ID 83401-2786 | 2019-07-10 |
| 1760950604 | Scott A Watkins | Nurse Practitioner | 2836 Cougar Ave, Nampa, ID 83687-9107 | 2018-11-08 |
| 1104309657 | Brigitta Panther | Nurse Practitioner | 418 W Reese St, Boise, ID 83706-6233 | 2018-09-11 |
| 1659870178 | Mark Mcgrath | Nurse Practitioner | 1309 Ponderosa Dr Ste 103, Sandpoint, ID 83864-8278 | 2018-02-10 |
| 1467855403 | Clint Emmett | Nurse Practitioner | 875 Perimeter Dr # Ms 3140, Moscow, ID 83844-2006 | 2014-10-06 |
| 1639507551 | Jason Martin | Nurse Practitioner | 13734 S 1st E, Idaho Falls, ID 83404-7852 | 2013-10-31 |
| 1881027241 | Colleen R Fleming | Nurse Practitioner | 2025 W Park Place, Ste B, Coeur D Alene, ID 83814-2785 | 2013-08-20 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.