Renu Medispa

NPI #1407129125 in Eagle, Idaho

Provider Information

NPI Number: 1407129125
Entity Type: Organization
Organization Name: Renu Medispa
Primary Specialty: Clinic/Center
Enumeration Date: Feb 10, 2012
Last Updated: Apr 30, 2012

Practice Location

Address: 951 E PLAZA DR
Address 2: SUITE 150
City: Eagle
State: Idaho
ZIP Code: 83616-6566
Phone: (208) 939-4456

Authorized Official

Name: MS. TAWNI WEAVER
Title: DIRECTOR
Phone: (208) 939-4456

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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