Provider Demographics
NPI:1669682381
Name:SONSHINE FAMILY HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:SONSHINE FAMILY HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-375-8806
Mailing Address - Street 1:2308 N COLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7361
Mailing Address - Country:US
Mailing Address - Phone:208-375-8806
Mailing Address - Fax:208-375-8826
Practice Address - Street 1:2308 N COLE RD STE H
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7361
Practice Address - Country:US
Practice Address - Phone:208-375-8806
Practice Address - Fax:208-375-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP524A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty