Healthcare Provider Details

I. General information

NPI: 1962267575
Provider Name (Legal Business Name): FORS FUNCTIONAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 E SKY BAR ST
BOISE ID
83716-8830
US

IV. Provider business mailing address

7008 E SKY BAR ST
BOISE ID
83716-8830
US

V. Phone/Fax

Practice location:
  • Phone: 208-805-0705
  • Fax:
Mailing address:
  • Phone: 208-805-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRETTA SNYDER FORS
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 208-805-0705