Organization
LIVE WELL HEALTH AND NUTRITION PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE BAHADAR NP (NP, OWNER)
(208) 861-4677
Entity
Organization
Contact information
Practice address
4700 N CLOVERDALE RD STE 103, BOISE, ID 83713-1067
(208) 392-8383
(208) 493-3062
Mailing address
4700 N CLOVERDALE RD STE 103, BOISE, ID 83713-1067
(208) 392-8383
(208) 493-3062
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP-1169A
STATE LICENSE
ID
Enumeration date
11/16/2017
Last updated
11/16/2017
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