Healthcare Provider Details

I. General information

NPI: 1972962181
Provider Name (Legal Business Name): CROSS NATURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 N CLOVERDALE RD SUITE 103
BOISE ID
83713-1081
US

IV. Provider business mailing address

2965 E TARPON DR SUITE 150
MERIDIAN ID
83642-9009
US

V. Phone/Fax

Practice location:
  • Phone: 208-392-8383
  • Fax: 866-575-9302
Mailing address:
  • Phone: 208-287-9420
  • Fax: 208-287-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1198A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM-12A
License Number StateID

VIII. Authorized Official

Name: KAREN CROSS
Title or Position: NP/OWNER
Credential: NP
Phone: 208-392-8383