# FORTIFY OPTIMAL HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FORTIFY OPTIMAL HEALTH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437945391
- **Authorized official:** SUSANNAH HANCOCK FNP (CEO)
- **Authorized official phone:** (619) 602-4520

## Contact information

- **Practice address:** 1189 RED ROBIN AVE, AMMON, ID 83401-5747
- **Practice address phone:** (619) 602-4520
- **Mailing address:** 784 SOUTH CLEAR LOOP STE R, POST FALLS, ID 83854
- **Mailing address phone:** (619) 602-4520

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2025
- **Last updated:** 04/17/2025