Organization
PRESTIGE WELLNESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEVI HANSEN (CEO)
(208) 705-9800
Entity
Organization
Contact information
Practice address
3749 E 343 N, RIGBY, ID 83442-5326
(208) 705-9800
Mailing address
3749 E 343 N, RIGBY, ID 83442-5326
(208) 705-9800
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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