Healthcare Provider Details

I. General information

NPI: 1952227647
Provider Name (Legal Business Name): JENNA SUE RANSBOTTOM CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA SUE COSPER CCMA

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 JOHN ADAMS PKWY
IDAHO FALLS ID
83401-4360
US

IV. Provider business mailing address

1214 CORNERSTONE DR
IDAHO FALLS ID
83401-3683
US

V. Phone/Fax

Practice location:
  • Phone: 208-432-1976
  • Fax: 208-278-7956
Mailing address:
  • Phone: 208-432-1976
  • Fax: 208-278-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberQ8P9S7K5
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: