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Organization
MIND AND BODY RESTORED
Active
Organization
MIND AND BODY RESTORED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANA QUALL NP (NP)
(208) 957-7808
Entity
Organization
Contact information
Practice address
913 W CANFIELD AVE, COEUR D ALENE, ID 83815-9764
(208) 957-7808
(949) 695-2456
Mailing address
3117 W AUGUSTIN DR, COEUR D ALENE, ID 83815-5362
(208) 957-7808
(949) 695-2456
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
NULL
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
04/10/2023
Last updated
12/05/2023
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