Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 7267 | TN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP-1631A | ID |
NPI | 1083670889 |
---|---|
Provider Name | Ms. Jana M Qualls |
First Address | Coeur D Alene, ID 83814-2785 |
Second Address | Coeur D Alene, ID 83814-2785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 13/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P43486 | (02) | |
P43486 | (02) | TN |