# LIFESPAN WELLNESS PLLC

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

## Provider details

- **NPI number:** 1366819310
- **Authorized official:** MRS. REBEKAH DANIELLE NATION APRN (OWNER/PSYCHIATRIC NP)
- **Authorized official phone:** (770) 324-7635

## Contact information

- **Practice address:** 1404 N MAIN ST, SUITE 101, MERIDIAN, ID 83642-2799
- **Practice address phone:** (208) 888-6264
- **Practice address fax:** (208) 906-2363
- **Mailing address:** 1404 N MAIN ST, SUITE 101, MERIDIAN, ID 83642-2799
- **Mailing address phone:** (208) 888-6264
- **Mailing address fax:** (208) 906-2363

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | NP-1536A | ID | Yes |

## Other

- **Enumeration date:** 08/25/2015
- **Last updated:** 02/24/2016