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General NPI Number Information
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NPI Number | 1063143659
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Entity Type | Organization
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Legal Business Name | JOURNEY HEALTHCARE LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1965 S EAGLE RD STE 180
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City | MERIDIAN
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State | ID
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Zip | 83642-9246
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Country | US
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Telephone | 986-666-3866
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Fax | 986-666-3038
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Provider Business Mailing Address
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Address Line | 1965 S EAGLE RD STE 180
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City | MERIDIAN
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State | ID
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Zip | 83642-9246
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Country | US
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Telephone | 986-666-3866
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Fax | 986-666-3038
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ALEXANDRIA MWANGA
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Credential | DNP, FNP-C
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Telephone | 208-380-9906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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