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NPI Code Detail

MEDICARE: MRS. JENNIFER M VINCENT DO

MEDICARE: MRS. JENNIFER M VINCENT DO
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
1207Q00000XFamily Medicine PhysicianO189ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215972831
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER M VINCENT DO
Provider Business Mailing Address
First Line : PO BOX 191050
Second Line :
City : BOISE
State : ID
Zip : 83719-1050
Country : US
Telephone Number : 208-955-6500
Fax Number : 208-955-6503
Provider Business Practice Location Address
First Line : 11197 W FAIRVIEW AVE
Second Line :
City : BOISE
State : ID
Zip : 83713-7935
Country : US
Telephone Number : 208-378-8011
Fax Number : 208-322-8095
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 01/18/2012

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