Organization
COMPLETE EMBODIMENT WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONI BENNETT (CREDENTIALING SPECIALIST)
(208) 810-2319
Entity
Organization
Contact information
Practice address
7683 W EMERALD ST, BOISE, ID 83704-9018
(208) 376-2522
Mailing address
PO BOX 44124, BOISE, ID 83711-0124
(208) 384-9022
(208) 947-3465
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/19/2022
Last updated
05/16/2023
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