Healthcare Provider Details

I. General information

NPI: 1982519724
Provider Name (Legal Business Name): JEANETE A CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 S FEDERAL WAY
BOISE ID
83705
US

IV. Provider business mailing address

10945 W IRVING CT
BOISE ID
83713-0616
US

V. Phone/Fax

Practice location:
  • Phone: 208-690-2401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number1075039
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: