Healthcare Provider Details
I. General information
NPI: 1841883741
Provider Name (Legal Business Name): TRUE NORTH WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/11/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1327 W SUPERIOR ST STE 104
SANDPOINT ID
83864-2742
US
IV. Provider business mailing address
1327 W SUPERIOR ST STE 104
SANDPOINT ID
83864-2742
US
V. Phone/Fax
- Phone: 208-946-5888
- Fax:
- Phone: 208-946-5888
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 175F00000X |
| Taxonomy | Naturopath |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
F
BLAKE
AMBRIDGE
Title or Position: OWNER/ADMINISTRATOR
Credential: ND
Phone: 208-946-5888