Organization
RENU MEDISPA
Active
Organization
RENU MEDISPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAWNI WEAVER (DIRECTOR)
(208) 939-4456
Entity
Organization
Contact information
Practice address
951 E PLAZA DR, SUITE 150, EAGLE, ID 83616-6566
(208) 939-4456
(208) 287-2200
Mailing address
951 E PLAZA DR, SUITE 150, EAGLE, ID 83616-6566
(208) 939-4456
(208) 287-2200
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
NP784A
ID
Other
Enumeration date
02/10/2012
Last updated
04/30/2012
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