# FUNCTIONAL MEDICINE OF NORTH IDAHO, PLLC

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

## Provider details

- **NPI number:** 1750920401
- **Authorized official:** JESSICA LAPLANTE ARNP (OWNER)
- **Authorized official phone:** (208) 635-5265

## Contact information

- **Practice address:** 8382 N WAYNE DR STE 204, HAYDEN, ID 83835-6028
- **Practice address phone:** (208) 635-5265
- **Practice address fax:** (208) 635-5218
- **Mailing address:** 1399 N BIZTOWN LOOP, HAYDEN, ID 83835-5044
- **Mailing address phone:** (208) 635-5265
- **Mailing address fax:** (208) 635-5218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/29/2019
- **Last updated:** 07/01/2024