Healthcare Provider Details

I. General information

NPI: 1700794427
Provider Name (Legal Business Name): JEANETTE ANGELL AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 CHRISTE RD
DONNELLY ID
83615-0392
US

IV. Provider business mailing address

PO BOX 392
DONNELLY ID
83615-0392
US

V. Phone/Fax

Practice location:
  • Phone: 208-859-9106
  • Fax:
Mailing address:
  • Phone: 208-859-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3681824
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: