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General NPI Number Information
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NPI Number | 1992655526
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Entity Type | Organization
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Legal Business Name | SACRED ROOTS FERTILITY CONSULTING, PLLC
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 176 E CALDERWOOD DR STE 125D
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City | MERIDIAN
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State | ID
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Zip | 83642-9095
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Country | US
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Telephone | 208-402-8946
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Fax | 208-248-6939
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Provider Business Mailing Address
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Address Line | 2169 W OAKHAMPTON DR
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City | EAGLE
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State | ID
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Zip | 83616-7632
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Country | US
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Telephone | 208-402-8946
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Fax | 208-248-6939
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Authorized Official
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Title or Position | CEO
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Name | BRENNAN NICOLE CARMODY
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Credential | NP, CEO
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Telephone | 208-631-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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