Provider Demographics
NPI:1962267575
Name:FORS FUNCTIONAL MEDICINE
Entity type:Organization
Organization Name:FORS FUNCTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GRETTA
Authorized Official - Middle Name:SNYDER
Authorized Official - Last Name:FORS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-805-0705
Mailing Address - Street 1:7008 E SKY BAR ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-8830
Mailing Address - Country:US
Mailing Address - Phone:208-805-0705
Mailing Address - Fax:
Practice Address - Street 1:7008 E SKY BAR ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-8830
Practice Address - Country:US
Practice Address - Phone:208-805-0705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORS HEALTH COACHING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty