Healthcare Provider Details

I. General information

NPI: 1013256379
Provider Name (Legal Business Name): SIMPLY WOMENS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 10/04/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S WOODDALE AVE
EAGLE ID
83616-7714
US

IV. Provider business mailing address

PO BOX 1278
EAGLE ID
83616-1278
US

V. Phone/Fax

Practice location:
  • Phone: 89-945-5752
  • Fax: 208-994-5576
Mailing address:
  • Phone: 208-994-5575
  • Fax: 208-994-5576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberN-27344
License Number StateID

VIII. Authorized Official

Name: ANA LABORDE
Title or Position: OWNER/PROVIDER
Credential: AGNP-BC
Phone: 208-994-5575