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General NPI Number Information
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NPI Number | 1073456786
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Entity Type | Individual
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Provider Name | JENNIFER FOGLE
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Gender | Female
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 5909 W STATE ST
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City | BOISE
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State | ID
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Zip | 83703-3039
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Country | US
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Telephone | 208-343-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 9143 W DALTON PL
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City | BOISE
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State | ID
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Zip | 83704-3275
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Country | US
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Telephone | 509-994-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS-3762
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License Number State | ID
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