Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | M9028 | ID |
NPI | 1316981632 |
---|---|
Provider Name | Jean U Bender |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 27/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10337 | (02) | ID |