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General NPI Number Information
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NPI Number | 1982519724
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Entity Type | Individual
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Provider Name | JEANETE A CARDONA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 3237 S FEDERAL WAY
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City | BOISE
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State | ID
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Zip | 83705
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Country | US
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Telephone | 208-690-2401
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Fax |
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Provider Business Mailing Address
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Address Line | 10945 W IRVING CT
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City | BOISE
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State | ID
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Zip | 83713-0616
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Country | US
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Telephone |
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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 | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 1075039
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License Number State | ID
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