Healthcare Provider Details

I. General information

NPI: 1669408860
Provider Name (Legal Business Name): JANE E SEYS NP CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 S. PLEASANT VALLEY RD IDAHO STATE CORRECTIONAL INSTITUTION
KUNA ID
83634
US

IV. Provider business mailing address

7301 W. E MERALD ST. SUITE 103 CORIZON
BOISE ID
83704
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-0740
  • Fax: 574-722-9523
Mailing address:
  • Phone: 208-322-3555
  • Fax: 208-322-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number70000035A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: