Provider Demographics
NPI:1689043739
Name:MALMENDIER, KIRSTEN (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:MALMENDIER
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:SPAINHOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 E STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-391-3732
Mailing Address - Fax:
Practice Address - Street 1:600 E STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-391-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACV-442171100000X
162319171100000X
CAAC16685171100000X
CA16685171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist