MEDICARE: JEANNA PADILLA CPNP-PC

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	363LP0200X	Pediatric Nurse Practitioner	61048	ID

General Provider Information

NPI Number	:	1134585763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNA PADILLA CPNP-PC

Provider Business Mailing Address
First Line	:	1593 E POLSTON AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5326
Country	:	US
Telephone Number	:	208-262-2300
Fax Number	:	208-262-2390

Provider Business Practice Location Address
First Line	:	7600 N MINERAL DR STE 110
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7763
Country	:	US
Telephone Number	:	208-619-8250
Fax Number	:	208-981-9201

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

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/05/2026

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Directions to “ JEANNA PADILLA CPNP-PC” Practice Location

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