Healthcare Provider Details

I. General information

NPI: 1659110005
Provider Name (Legal Business Name): SIERRA JEPPESEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

IV. Provider business mailing address

3307 CALDWELL BLVD STE 104
NAMPA ID
83651-6403
US

V. Phone/Fax

Practice location:
  • Phone: 208-465-4833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: