Provider Demographics
NPI:1083484877
Name:BODY BALANCE HEALTH AND WELLNESS CLINIC LLC
Entity Type:Organization
Organization Name:BODY BALANCE HEALTH AND WELLNESS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:406-261-4062
Mailing Address - Street 1:411 ORCHARD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7565
Mailing Address - Country:US
Mailing Address - Phone:406-261-4062
Mailing Address - Fax:
Practice Address - Street 1:1297 BURNS WAY STE 2
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3162
Practice Address - Country:US
Practice Address - Phone:406-755-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty