Provider Demographics
NPI:1003357500
Name:PALOUSE WOMEN'S WELLNESS LLC
Entity Type:Organization
Organization Name:PALOUSE WOMEN'S WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-503-6320
Mailing Address - Street 1:106 E 3RD ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2970
Mailing Address - Country:US
Mailing Address - Phone:208-503-6320
Mailing Address - Fax:
Practice Address - Street 1:106 E 3RD ST STE 3B
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2970
Practice Address - Country:US
Practice Address - Phone:208-503-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty