Organization
KORENA POPP FNP MEDICAL SERVICES LLC
Active
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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