Healthcare Provider Details

I. General information

NPI: 1295663748
Provider Name (Legal Business Name): FREESTONE FAMILY MEDICINE AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 CENTER PARK DRIVE
AMMON ID
83406
US

IV. Provider business mailing address

2184 CHANNING WAY # 234
IDAHO FALLS ID
83404-8034
US

V. Phone/Fax

Practice location:
  • Phone: 208-768-6959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN TOENJES
Title or Position: PHYSICIAN/OWNER
Credential: DO
Phone: 208-313-3792