Organization
CENTER FOR LIFETIME HEALTH
Active
Other names
Colleen Shackelford, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN SHACKELFORD DNP (OWNER)
(208) 342-7400
Entity
Organization
Contact information
Practice address
300 E BANNOCK ST, BOISE, ID 83712
(208) 342-7400
(208) 342-1879
Mailing address
300 E BANNOCK ST, BOISE, ID 83712
(208) 342-7400
(208) 342-1879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5741
ID
Other
Enumeration date
11/08/2006
Last updated
07/25/2023
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