POCATELLO WELLNESS CLINIC LLC NPI 1437615952

NPI Information

NPI: 1437615952
Provider Name: POCATELLO WELLNESS CLINIC LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 13D2179047

Address:
1155 YELLOWSTONE AVE STE D
POCATELLO, ID
ZIP 83201
Phone: (208) 637-9610
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POCATELLO WELLNESS CLINIC LLC is a family nurse practitioner in Pocatello, ID. POCATELLO WELLNESS CLINIC LLC NPI is 1437615952. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1155 YELLOWSTONE AVE STE D
POCATELLO, ID
ZIP 83201-369
Phone: (208) 637-9610
Fax: (208) 238-6162

The provider's authorized official is Dustin Reno .
The authorized official title is Owner and has the following contact phone number (208) 221-0538.

The CLIA number assigned to this NPI record is 13D2179047 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/20/2019 and was last updated on 3/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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