Healthcare Provider Details

I. General information

NPI: 1679688030
Provider Name (Legal Business Name): HEALING ARTS WOMEN'S CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W IOWA AVE STE 225
NAMPA ID
83686-6815
US

IV. Provider business mailing address

222 W IOWA AVE STE 225
NAMPA ID
83686-6815
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-6666
  • Fax: 208-467-6680
Mailing address:
  • Phone: 208-467-6666
  • Fax: 208-467-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SEAN F LYNN
Title or Position: PRESIDENT
Credential: MD
Phone: 208-467-6666