Healthcare Provider Details

I. General information

NPI: 1326731803
Provider Name (Legal Business Name): JACQUELYN GINTER BSRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5709 E EFFRA ST
NAMPA ID
83687-7611
US

IV. Provider business mailing address

5709 E EFFRA ST
NAMPA ID
83687-7611
US

V. Phone/Fax

Practice location:
  • Phone: 661-437-0499
  • Fax:
Mailing address:
  • Phone: 661-437-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberLRT-2262
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberLRT-2262
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberLRT-2262
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberLRT-2262
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberLRT-2262
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: