Provider Demographics
NPI:1649156142
Name:SNAKE RIVER WELLNESS PLLC
Entity type:Organization
Organization Name:SNAKE RIVER WELLNESS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:208-366-1200
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:GLENNS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83623-0102
Mailing Address - Country:US
Mailing Address - Phone:208-366-1200
Mailing Address - Fax:
Practice Address - Street 1:94 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:GLENNS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83623-2342
Practice Address - Country:US
Practice Address - Phone:208-366-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty