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General NPI Number Information
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NPI Number | 1205143120
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Entity Type | Organization
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Legal Business Name | WOMEN'S WELLNESS & AESTHETICS
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Dates
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Enumeration Date | 09/13/2010
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Last Update Date | 09/13/2010
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Provider Practice Location Address
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Address Line | 6650 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8738
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Country | US
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Telephone | 208-323-5580
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Fax | 208-323-5693
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Provider Business Mailing Address
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Address Line | 6650 W EMERALD ST
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City | BOISE
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State | ID
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Zip | 83704-8738
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Country | US
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Telephone | 208-323-5580
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Fax | 208-323-5693
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Authorized Official
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Title or Position | NP
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Name | MRS. ELIZABETH A BRITAIN
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Credential | NP
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Telephone | 208-323-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SW0102X
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Taxonomy Name | Women's Health Clinical Nurse Specialist
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License Number | NP265A
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License Number State | ID
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