Organization
LIFESPAN PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY ANN HALL FNP-C (OWNER)
(208) 736-7090
Entity
Organization
Contact information
Practice address
224 MARTIN ST, SUITE B, TWIN FALLS, ID 83301-4542
(208) 736-7090
(208) 736-7089
Mailing address
224 MARTIN ST, SUITE B, TWIN FALLS, ID 83301-4542
(208) 736-7090
(208) 736-7089
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP717A
ID
Other
Enumeration date
11/13/2006
Last updated
08/22/2020
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