Intermountain Functional Medicine, Pllc

LBN: Intermountain Functional Medicine, Pllc
Intermountain Functional Medicine, Pllc is an health care organization with primary practice located at 913 S Allante Pl , Boise ID 83709-1612. The organization recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as the primary health care specialty. Intermountain Functional Medicine, Pllc can be contacted via phone (208) 947-5390, or through Bowen, Kathy L via phone (208) 947-5390.

Contact Information

Primary practice address
913 S Allante Pl Boise ID 83709-1612
Phone: (208) 947-5390
Fax: (208) 947-3465
Website:
Map and Directions
Authorized official contact:
Name: Bowen, Kathy L FNP-C
Phone: (208) 947-5390

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X NP816A Idaho

Profile Details

NPI number 1659719177
LBN Legal business name Intermountain Functional Medicine, Pllc
DBA Doing business as
Authorized official Bowen, Kathy L FNP-C
Entity Organization
Organization subpart 1 No
Enumeration date Jun 6th, 2013
Last updated Jun 6th, 2013 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659719177 NPPES
Idaho Other NP816A LICENSE NUMBER

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