Healthcare Provider Details

I. General information

NPI: 1972425106
Provider Name (Legal Business Name): MRS. MEGHAN L WOOLSTENHULME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 N 800 W
BLACKFOOT ID
83221-5388
US

IV. Provider business mailing address

128 N 800 W
BLACKFOOT ID
83221-5388
US

V. Phone/Fax

Practice location:
  • Phone: 208-690-1175
  • Fax:
Mailing address:
  • Phone: 208-690-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number77570
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: