Healthcare Provider Details

I. General information

NPI: 1790622819
Provider Name (Legal Business Name): JENNIFER C MAIRE DNP PMHNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E 4TH N
REXBURG ID
83440-6002
US

IV. Provider business mailing address

1999 S 25TH E STE 1016
AMMON ID
83406-5710
US

V. Phone/Fax

Practice location:
  • Phone: 208-671-7013
  • Fax: 208-932-4319
Mailing address:
  • Phone: 208-671-7013
  • Fax: 208-932-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CHRISTINE MAIRE
Title or Position: OWNER, DNP, PMHNP
Credential: DNP, PMHNP-BC
Phone: 208-671-7013