Organization
POCATELLO WELLNESS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN RENO NP (OWNER)
(208) 637-9610
Entity
Organization
Contact information
Practice address
1155 YELLOWSTONE AVE, STE D, POCATELLO, ID 83201-4369
(208) 637-9610
(208) 238-6162
Mailing address
1155 YELLOWSTONE AVE, STE D, POCATELLO, ID 83201-4369
(208) 637-9610
(208) 238-6162
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/20/2019
Last updated
04/23/2024
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