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Organization
GEN STATE INTEGRATIVE MEDICINE
Active
Organization
GEN STATE INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER LYN PETRIE MD (OWNER/PRESIDENT)
(208) 365-7131
Entity
Organization
Contact information
Practice address
1500 EAST HERITAGE PARK LANE, SUITE 150, SUITE 150, MERIDIAN, ID 83646
(208) 202-7247
(208) 202-7246
Mailing address
1500 EAST HERITAGE PARK LANE, SUITE 150, SUITE 150, MERIDIAN, ID 83646
(208) 202-7247
(208) 202-7246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/06/2026
Last updated
08/06/2026
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