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General NPI Number Information
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NPI Number | 1174333694
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Entity Type | Individual
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Provider Name | KENDALL VANJO FNP, RN
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Gender | Female
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 2330 W EVEREST LN SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 208-297-4091
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Fax |
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Provider Business Mailing Address
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Address Line | 3628 N COSTA MADERA WAY
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City | STAR
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State | ID
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Zip | 83669-1127
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Country | US
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Telephone | 805-807-5877
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6961274
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License Number State | ID
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