| Organization Name: | LIFESPAN PRIMARY CARE LLC |
| NPI Number: | 1023189800 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BEVERLY ANN HALL (OWNER) |
| Mailing Address: | 224 Martin St Suite B Twin Falls |
| State: | ID US |
| Postal Code: | 833014542 |
| Phone Number: | 2087367090 |
| Fax Number: | 2087367089 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP717A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |