Organization
INTERMOUNTAIN FUNCTIONAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY L BOWEN FNP-C (SOLE MEMBER)
(208) 947-5390
Entity
Organization
Contact information
Practice address
913 S ALLANTE PL, BOISE, ID 83709-1612
(208) 947-5390
(208) 947-3465
Mailing address
13960 W WAINWRIGHT DR, BOISE, ID 83713-1969
(208) 947-5390
(208) 947-3465
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP816A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP816A
LICENSE NUMBER
ID
Enumeration date
06/06/2013
Last updated
06/06/2013
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