Provider Demographics
NPI:1205143120
Name:WOMEN'S WELLNESS & AESTHETICS
Entity type:Organization
Organization Name:WOMEN'S WELLNESS & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRITAIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-323-5580
Mailing Address - Street 1:6650 W EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8738
Mailing Address - Country:US
Mailing Address - Phone:208-323-5580
Mailing Address - Fax:208-323-5693
Practice Address - Street 1:6650 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8738
Practice Address - Country:US
Practice Address - Phone:208-323-5580
Practice Address - Fax:208-323-5693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP265A364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's HealthGroup - Single Specialty