Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 60215 | ID |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 60215 | ID |
NPI | 1538631189 |
---|---|
Provider Name | Jennifer Dawn Rice |
First Address | Meridian, ID 83642-7888 |
Second Address | Boise, ID 83709-0021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1538631189 | (05) | ID |