Provider Demographics
NPI:1295882850
Name:SOLACE, BRANETTE BEAN (NMD)
Entity type:Individual
Prefix:DR
First Name:BRANETTE
Middle Name:BEAN
Last Name:SOLACE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:BRANETTE
Other - Middle Name:JO
Other - Last Name:SOLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:301 COLORADO STREET
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-0129
Mailing Address - Country:US
Mailing Address - Phone:208-634-7289
Mailing Address - Fax:208-634-1082
Practice Address - Street 1:301 COLORADO ST.
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-0129
Practice Address - Country:US
Practice Address - Phone:208-634-7289
Practice Address - Fax:208-634-1082
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001529175F00000X
IDNMD-0007175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath