MEDICARE: JENNIFER G PALMER FNP

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	363LF0000X	Family Nurse Practitioner	NP-1412A	ID

General Provider Information

NPI Number	:	1235556051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER G PALMER FNP

Provider Business Mailing Address
First Line	:	8500 N ATLAS RD
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-8332
Country	:	US
Telephone Number	:	208-415-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N ATLAS RD
Second Line	:
City	:	HAYDEN
State	:	ID
Zip	:	83835-8332
Country	:	US
Telephone Number	:	208-415-5100
Fax Number	:

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

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	02/18/2016

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