Provider Demographics
NPI:1942699715
Name:WHOLESOME HEALTH
Entity Type:Organization
Organization Name:WHOLESOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARAMIE
Authorized Official - Middle Name:LINNING
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-589-3846
Mailing Address - Street 1:3040 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6760
Mailing Address - Country:US
Mailing Address - Phone:208-557-0200
Mailing Address - Fax:208-542-5080
Practice Address - Street 1:3040 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6760
Practice Address - Country:US
Practice Address - Phone:208-557-0200
Practice Address - Fax:208-542-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-17
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0426207Q00000X
IDNP676A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty