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General NPI Number Information
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NPI Number | 1801376066
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Entity Type | Organization
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Legal Business Name | NEXGEN MENTAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 3152 S BOWN WAY STE 101
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City | BOISE
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State | ID
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Zip | 83706-5456
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Country | US
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Telephone | 208-922-7055
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Fax | 208-576-6930
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Provider Business Mailing Address
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Address Line | 3152 S BOWN WAY STE 101
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City | BOISE
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State | ID
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Zip | 83706-5456
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Country | US
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Telephone | 208-922-7055
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Fax | 208-576-6930
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DONNA J CHRISTENSEN
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Credential | NP
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Telephone | 208-922-7055
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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 | NP-922A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP-922A
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License Number State | ID
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