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General NPI Number Information
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NPI Number | 1134585763
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Entity Type | Individual
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Provider Name | JEANNA PADILLA CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 7600 N MINERAL DR STE 600
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9169
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Country | US
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Telephone | 208-619-8250
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Fax | 208-981-9201
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Provider Business Mailing Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2300
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Fax | 208-262-2390
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 61048
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License Number State | ID
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