Lifespan Wellness PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

NP-1536A Issued in ID

Legal business name

LIFESPAN WELLNESS PLLC

Practice address

1404 N Main St
Suite 101
Meridian, ID 83642-2799

Phone

(208) 888-6264

Fax

(208) 906-2363

NPI assigned

Aug 25, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Rebekah Danielle Nation, APRNNPI 1134497464

Title

Owner/Psychiatric NP

Phone

(770) 324-7635

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rebekah Danielle Nation, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1134497464
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1366819310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422799",
            "telephone_number": "208-888-6264",
            "fax_number": "208-906-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 N MAIN ST",
            "address_2": "SUITE 101",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422799",
            "telephone_number": "208-888-6264",
            "fax_number": "208-906-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPAN WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-25",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "NATION",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_middle_name": "DANIELLE",
        "authorized_official_title_or_position": "OWNER/PSYCHIATRIC NP",
        "authorized_official_telephone_number": "770-324-7635",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ID",
            "license": "NP-1536A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Meridian, ID
• Providers in Meridian, ID by specialty
• Psychiatric/Mental Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.