Provider Demographics
NPI:1548952807
Name:HUNTER RYDEN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HUNTER RYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12676 ROCKLEDGE LN
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5406
Mailing Address - Country:US
Mailing Address - Phone:208-617-4002
Mailing Address - Fax:
Practice Address - Street 1:12676 ROCKLEDGE LN
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5406
Practice Address - Country:US
Practice Address - Phone:208-617-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCFH9078253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care