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General NPI Number Information
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NPI Number | 1295545564
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Entity Type | Organization
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Legal Business Name | IDAHO HEALTH AND HORMONES
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 2667 E GALA CT STE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-2791
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Country | US
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Telephone | 208-268-8851
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Fax | 208-391-5526
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Provider Business Mailing Address
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Address Line | 2667 E GALA CT STE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-2791
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Country | US
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Telephone | 208-268-8851
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Fax | 208-391-5526
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Authorized Official
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Title or Position | COO
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Name | JACLYN WOLSKE
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Credential |
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Telephone | 208-268-8851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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