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ESSENTIAL LIFE BOISE
NPI 1841550126
Clinic/Center - Medical Specialty in Boise, ID

Active since May 21, 2012
13125 W PERSIMMON LN, STE 100, BOISE, ID 83713(208) 991-0352 Get Directions Write a Review

NPPES record last updated: August 27, 2012. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Other Providers Same Location
  5. Frequently Asked Questions
  • Organization
  • Clinic/Center
  • Medical Specialty

About ESSENTIAL LIFE BOISE

This page provides the complete NPI Profile along with additional information for Essential Life Boise, a provider established in Boise, Idaho operating as a Clinic/center, focusing in medical specialty . The healthcare provider is registered in the NPI registry with number 1841550126 assigned on May 2012. The practitioner's primary taxonomy code is 261QM2500X with license number CHIA1466 (ID). The provider is registered as an organization and their NPI record was last updated 14 years ago. The authorized official of this NPI record is Dr. Yvonne Fedewa (Owner)

NPI
1841550126 Verify this NPI
Provider Name
ESSENTIAL LIFE BOISE
Entity Type
Organization
Location Address
13125 W PERSIMMON LN STE 100 BOISE, ID 83713
Location Phone
(208) 991-0352
Mailing Address
13125 W PERSIMMON LN STE 100 BOISE, ID 83713
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
05-21-2012
Last Update Date
08-27-2012
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Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Medical Specialty

Taxonomy Code
261QM2500X
Type
Ambulatory Health Care Facilities
License No.
CHIA1466
License State
ID
Taxonomy Description
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

DR. YVONNE FEDEWA

Authorized Official Title
OWNER
Authorized Official Phone
(208) 991-0352

Reviews for ESSENTIAL LIFE BOISE

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Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

ESSENTIAL LIFE BOISE, LLC
Clinic/Center (Medical Specialty)
13125 W PERSIMMON LN, SUITE 100
BOISE, ID 83713
Ada County (208) 991-0352
DR. YVONNE ROSE FEDEWA AICHER D.C.
Chiropractor
13125 W PERSIMMON LN, SUITE 100
BOISE, ID 83713
Ada County (208) 991-0352

Frequently Asked Questions

What is ESSENTIAL LIFE BOISE's NPI number?

The NPI number assigned to this healthcare provider is 1841550126, enumerated as an "organization" on May 21, 2012.

Where is the provider located?

The provider is located at 13125 W PERSIMMON LN STE 100 BOISE, ID 83713 and the phone number is (208) 991-0352.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QM2500X and a focus in Medical Specialty.