Provider Demographics
NPI:1841798535
Name:TREE OF LIFE INTEGRATIVE HEALTH INC
Entity Type:Organization
Organization Name:TREE OF LIFE INTEGRATIVE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYMBRE
Authorized Official - Middle Name:SANDS
Authorized Official - Last Name:GOVERNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:720-429-5748
Mailing Address - Street 1:310 JUDSON ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4815
Mailing Address - Country:US
Mailing Address - Phone:720-429-5748
Mailing Address - Fax:
Practice Address - Street 1:310 JUDSON ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4815
Practice Address - Country:US
Practice Address - Phone:720-429-5748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty