OrganizationActive
Essential Life Boise, LLC
NPI 1669727400 · Medical Specialty Clinic/Center · Boise, ID
Provider details
- NPI number
- 1669727400
- Entity type
- Organization
- Primary specialty
- Medical Specialty Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Yvonne Fedewa, Owner(208) 991-0352
- License
- CHIA1466 (ID)
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
13125 W Persimmon Ln
Suite 100
Boise, ID 83713
Phone: (208) 991-0352
Approximate (ZIP-level) locationGet directions
Mailing address
13125 W Persimmon Ln
Boise, ID 83713
Registry dates
- Enumerated
- 2012-07-18
- Last updated
- 2012-07-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.