MEDICARE: MS. JAYNE S SHODA MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP956A	ID

General Provider Information

NPI Number	:	1003817701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAYNE S SHODA MSN, FNP-C

Provider Business Mailing Address
First Line	:	915 W. EMMA AVE
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83814
Country	:	US
Telephone Number	:	208-964-0701
Fax Number	:	818-365-4031

Provider Business Practice Location Address
First Line	:	1983 E LOOKOUT DR
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7046
Country	:	US
Telephone Number	:	208-964-0701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/07/2024

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