Organization
TRANSFORMED MIND AND BODY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONIRUTH DIGAUM NP (NURSE PRACTITIONER)
(407) 865-0101
Entity
Organization
Contact information
Practice address
824 17TH AVE S STE 15, NAMPA, ID 83651-4780
(407) 865-0101
Mailing address
8040 S RED CLIFF AVE, BOISE, ID 83716-3466
(407) 865-0101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/02/2024
Last updated
10/02/2024
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