Provider Demographics
NPI: | 1558943779 |
---|---|
Name: | LB MEDICAL CONSULTANTS |
Entity Type: | Organization |
Organization Name: | LB MEDICAL CONSULTANTS |
Other - Org Name: | H3OWELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICOLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARTLETT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DNP, AGACNP, PHMNP |
Authorized Official - Phone: | 559-681-6000 |
Mailing Address - Street 1: | 704 2ND AVE N |
Mailing Address - Street 2: | |
Mailing Address - City: | TWIN FALLS |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83301-5746 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 559-681-6000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 704 2ND AVE N |
Practice Address - Street 2: | |
Practice Address - City: | TWIN FALLS |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83301-5746 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-207-9422 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-04-27 |
Last Update Date: | 2022-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |