Healthcare Provider Details

I. General information

NPI: 1265345235
Provider Name (Legal Business Name): MIND AND BODY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 W JUDITH LN STE 220
BOISE ID
83705-3138
US

IV. Provider business mailing address

3527 S FEDERAL WAY STE 103-414
BOISE ID
83705-5204
US

V. Phone/Fax

Practice location:
  • Phone: 208-918-4080
  • Fax: 208-473-7338
Mailing address:
  • Phone: 208-918-4080
  • Fax: 208-473-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TAMARA MCDONALD
Title or Position: OWNER
Credential: DNP
Phone: 208-918-4080