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General NPI Number Information
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NPI Number | 1326003377
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Entity Type | Individual
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Provider Name | MARY PAIGE JEFFRESS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 4750 N FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83713-2715
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Country | US
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Telephone | 208-375-0500
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Fax | 208-375-4310
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Provider Business Mailing Address
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Address Line | 2808 S DENALI PL
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City | MERIDIAN
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State | ID
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Zip | 83642-8103
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Country | US
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Telephone | 208-288-1229
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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 | APN00541
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License Number State | NV
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