MEDICARE: MR. CHRISTOPHER JAY SJOBERG NP

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	NP903A	ID

General Provider Information

NPI Number	:	1235122284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER JAY SJOBERG NP

Provider Business Mailing Address
First Line	:	18001 E 10 MILE RD
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-3803
Country	:	US
Telephone Number	:	208-367-3069
Fax Number	:	208-367-3002

Provider Business Practice Location Address
First Line	:	1055 N CURTIS RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-1309
Country	:	US
Telephone Number	:	208-367-3069
Fax Number	:	208-367-3002

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/01/2017

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