Organization
ESSENTIAL LIFE BOISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YVONNE FEDEWA (OWNER)
(208) 991-0352
Entity
Organization
Contact information
Practice address
13125 W PERSIMMON LN, STE 100, BOISE, ID 83713-2086
(208) 991-0352
Mailing address
13125 W PERSIMMON LN, STE 100, BOISE, ID 83713-2086
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
CHIA1466
ID
Other
Enumeration date
05/21/2012
Last updated
08/27/2012
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