Healthcare Provider Details

I. General information

NPI: 1831364512
Provider Name (Legal Business Name): BOISE NATUROPATHIC MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 N STOKESBERRY PL
MERIDIAN ID
83646
US

IV. Provider business mailing address

2524 N STOKESBERRY PL
MERIDIAN ID
83646
US

V. Phone/Fax

Practice location:
  • Phone: 208-373-7733
  • Fax: 208-373-7755
Mailing address:
  • Phone: 208-373-7733
  • Fax: 208-373-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACC-51
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberACC51
License Number StateID

VIII. Authorized Official

Name: BRANDI S. SWEET
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-373-7733