MEDICARE: JENNIFER ANN FULTON HOFER NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP1702A	ID

General Provider Information

NPI Number	:	1215396478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANN FULTON HOFER NP-C

Provider Business Mailing Address
First Line	:	1883 WILDWOOD ST STE C
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5146
Country	:	US
Telephone Number	:	208-901-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1883 WILDWOOD ST STE C
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5146
Country	:	US
Telephone Number	:	208-901-7006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	06/04/2021

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