# ID PHS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245613967
- **Authorized official:** NICOLE HOWARD (CEO)
- **Authorized official phone:** (337) 991-9276

## Contact information

- **Practice address:** 950 W. BANNCOCK STREET STE 1100, BOISE, ID 83702-6140
- **Practice address phone:** (337) 991-9276
- **Practice address fax:** (337) 991-9288
- **Mailing address:** 1509 DULLES DR, LAFAYETTE, LA 70506-3718
- **Mailing address phone:** (337) 991-9276
- **Mailing address fax:** (337) 991-9288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/30/2015
- **Last updated:** 06/30/2015