# ESSENTIAL LIFE BOISE

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

## Provider details

- **NPI number:** 1841550126
- **Authorized official:** DR. YVONNE FEDEWA (OWNER)
- **Authorized official phone:** (208) 991-0352

## Contact information

- **Practice address:** 13125 W PERSIMMON LN, STE 100, BOISE, ID 83713-2086
- **Practice address phone:** (208) 991-0352
- **Mailing address:** 13125 W PERSIMMON LN, STE 100, BOISE, ID 83713-2086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | CHIA1466 | ID | Yes |

## Other

- **Enumeration date:** 05/21/2012
- **Last updated:** 08/27/2012