Organization
KORENA POPP FNP MEDICAL SERVICES LLC
Active
Other names
The Change Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KORENA LYNN POPP (NP)
(208) 325-3500
Entity
Organization
Contact information
Practice address
454 W ROSEBERRY RD. STE 104, DONNELLY, ID 83615-8361
(208) 325-3500
(208) 325-3501
Mailing address
PO BOX 172, DONNELLY, ID 83615-0172
(208) 325-3500
(208) 325-3501
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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