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General NPI Number Information
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NPI Number | 1326605429
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Entity Type | Organization
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Legal Business Name | SHINING LITE WEIGHT MANAGEMENT & PERSONAL SOLUTIONS, LLC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4483 N DRESDEN PL STE 102
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City | GARDEN CITY
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State | ID
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Zip | 83714-5092
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Country | US
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Telephone | 208-639-2333
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Fax | 208-957-5769
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Provider Business Mailing Address
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Address Line | 8700 W ATWATER DR
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City | GARDEN CITY
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State | ID
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Zip | 83714-1299
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Country | US
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Telephone | 208-559-4597
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Fax | 208-957-5769
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Authorized Official
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Title or Position | MEMBER/PROVIDER
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Name | TAMARA F BETHEL
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Credential | DNP, APRN, FNP
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Telephone | 208-639-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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