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General NPI Number Information
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NPI Number | 1427126127
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Entity Type | Individual
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Provider Name | JESSICA N WASIELEWSKI MD
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Gender | Female
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 1055 N CURTIS RD
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City | BOISE
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State | ID
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Zip | 83706-1309
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Country | US
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Telephone | 208-367-2130
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Fax | 208-322-1731
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Provider Business Mailing Address
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Address Line | 2963 E COPPER POINT DR SUITE 150
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City | MERIDIAN
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State | ID
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Zip | 83642-9055
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Country | US
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Telephone | 208-322-1730
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Fax | 208-322-1731
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | EC-05-030
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD183358
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-10203
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License Number State | ID
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