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Illumination Women's Health PLLC

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Company Details

Name: Illumination Women's Health PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 05 Sep 2023 (2 years ago)
Financial Date End: 30 Sep 2025
Entity Number: 5384449
Place of Formation: IDAHO
File Number: 896927
ZIP code: 83706
County: Ada County
Principal Address: STE C200 4477 W EMERALD ST BOISE, ID 83706-2074

Member

Name Role Address Appointed On
KANDISS INMAN Member 4477 W EMERALD ST, BOISE, ID 83706-2074 2024-08-09

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1447032594
Certification Date:
2025-01-02

Authorized Person:

Name:
MRS. KANDISS INMAN
Role:
NURSE PRACTITIONER/OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LW0102X - Women's Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
8554909559

Filing

Filing Name Filing Number Filing date
Annual Report 0005853946 2024-08-09
Amendment to Certificate 0005723563 2024-05-05
Statement of Change of Business Mailing Address 0005596837 2024-02-10
Statement of Change of Business Mailing Address 0005444514 2023-10-19
Initial Filing 0005384449 2023-09-05

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Date of last update: 11 Jul 2025

Sources: Idaho Secretary of State