Healthcare Provider Details

I. General information

NPI: 1376573170
Provider Name (Legal Business Name): JANET K ROSCOE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST SUITE 302
BOISE ID
83712-6267
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-7501
  • Fax: 208-336-8248
Mailing address:
  • Phone: 208-343-7501
  • Fax: 208-336-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP588A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: