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General NPI Number Information
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NPI Number | 1790622819
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Entity Type | Organization
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Legal Business Name | JENNIFER C MAIRE DNP PMHNP
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 343 E 4TH N
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City | REXBURG
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State | ID
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Zip | 83440-6002
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Country | US
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Telephone | 208-671-7013
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Fax | 208-932-4319
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Provider Business Mailing Address
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Address Line | 1999 S 25TH E STE 1016
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City | AMMON
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State | ID
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Zip | 83406-5710
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Country | US
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Telephone | 208-671-7013
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Fax | 208-932-4319
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Authorized Official
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Title or Position | OWNER, DNP, PMHNP
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Name | JENNIFER CHRISTINE MAIRE
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Credential | DNP, PMHNP-BC
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Telephone | 208-671-7013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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