Organization
PREVENTATIVE HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE BENNION (OWNER)
(208) 853-2273
Entity
Organization
Contact information
Practice address
531 S FITNESS PL STE 100, EAGLE, ID 83616-6552
(208) 853-2273
Mailing address
531 S FITNESS PL, 100, EAGLE, ID 83616-6552
(208) 853-2273
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
291U00000X
Clinical Medical Laboratory
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/19/2011
Last updated
04/10/2017
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