Healthcare Provider Details

I. General information

NPI: 1306691829
Provider Name (Legal Business Name): ESLIM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 E SUNNYSIDE RD
IDAHO FALLS ID
83404-7328
US

IV. Provider business mailing address

1270 E SUNNYSIDE RD
IDAHO FALLS ID
83404-7328
US

V. Phone/Fax

Practice location:
  • Phone: 208-821-1395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL VOSS
Title or Position: OWNER
Credential: NP
Phone: 208-821-1395