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General NPI Number Information
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NPI Number | 1831827310
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Entity Type | Organization
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Legal Business Name | EROS HEALTH, LLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 800 W MAIN ST STE 1460
-----------------------------------------------------
City | BOISE
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State | ID
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Zip | 83702-5983
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Country | US
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Telephone | 208-352-2290
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Fax | 833-471-6098
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Provider Business Mailing Address
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Address Line | 1301 S MILLSTREAM DR
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City | NAMPA
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State | ID
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Zip | 83686-4837
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Country | US
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Telephone | 208-559-6494
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Fax |
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | JENNIFER JEAN MIMISH
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Credential | CNM, WHNP
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Telephone | 208-559-6494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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