Healthcare Provider Details

I. General information

NPI: 1376209460
Provider Name (Legal Business Name): KJERANNE RUMMEL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 E LOUISE DR
MERIDIAN ID
83642-9359
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7335
  • Fax: 208-381-7227
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69734
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: