Provider Demographics
NPI:1326345661
Name:ALLANTE FAMILY MEDICINE
Entity Type:Organization
Organization Name:ALLANTE FAMILY MEDICINE
Other - Org Name:ALLANTE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-337-5433
Mailing Address - Street 1:909 S ALLANTE PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1612
Mailing Address - Country:US
Mailing Address - Phone:208-377-5433
Mailing Address - Fax:208-377-1184
Practice Address - Street 1:909 S ALLANTE PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1612
Practice Address - Country:US
Practice Address - Phone:208-377-5433
Practice Address - Fax:208-377-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-927363LF0000X
IDNP-980-A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty