Healthcare Provider Details

I. General information

NPI: 1043480445
Provider Name (Legal Business Name): JESSICA GARNER CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 CURTISIAN AVE
BOISE ID
83704-8880
US

IV. Provider business mailing address

6140 CURTISIAN AVE
BOISE ID
83704-8880
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-2834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number100349
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: