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General NPI Number Information
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NPI Number | 1770175614
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Entity Type | Individual
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Provider Name | JONELLE HUDSON APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 05/04/2021
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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 | 208-367-3131
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Fax | 208-367-4858
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Provider Business Mailing Address
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Address Line | 9237 W PREECE ST
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City | BOISE
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State | ID
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Zip | 83704-8189
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Country | US
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Telephone | 208-440-5206
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Fax | 208-367-4858
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 202102336NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP67373
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP67373
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License Number State | ID
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