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Functional Medicine of North Idaho PLLC

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Company Details

Name: Functional Medicine of North Idaho PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 19 Oct 2019 (6 years ago)
Financial Date End: 31 Oct 2025
Entity Number: 3651268
Place of Formation: IDAHO
File Number: 684626
ZIP code: 83858
County: Kootenai County
Principal Address: 21028 N COCHRAN LANE RATHDRUM, ID 83858
Mailing Address: STE 204 8382 N WAYNE DR HAYDEN, ID 83835-6028

Agent

Name Role Address
Jessica LaPlante Agent 21028 N COCHRAN LANE, RATHDRUM, ID 83858

Manager

Name Role Address Appointed On
Jessica L LaPlante Manager 21028 N COCHRAN LN, RATHDRUM, ID 83835 2020-10-04

National Provider Identifier

NPI Number:
1750920401
Certification Date:
2024-07-01

Authorized Person:

Name:
JESSICA LAPLANTE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2086355218

Filing

Filing Name Filing Number Filing date
Annual Report 0005900397 2024-09-13
Annual Report 0005404469 2023-09-18
Annual Report 0004885754 2022-09-06
Annual Report 0004400727 2021-09-03
Annual Report 0004022107 2020-10-04

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Date of last update: 07 Jul 2025

Sources: Idaho Secretary of State