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General NPI Number Information
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NPI Number | 1710565551
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Entity Type | Individual
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Provider Name | JENNIFER L ROUSE
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Gender | Female
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 412 S MAIN ST
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City | TROY
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State | ID
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Zip | 83871-5009
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Country | US
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Telephone | 208-835-5550
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Fax | 208-835-5554
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Provider Business Mailing Address
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Address Line | 700 S MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-3046
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Country | US
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Telephone | 208-289-3841
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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 | 67523
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License Number State | ID
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