MEDICARE: DR. NANI JANE CABRERA DO

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	207Q00000X	Family Medicine Physician	DO27065	OR
2	207Q00000X	Family Medicine Physician	O0372	ID

General Provider Information

NPI Number	:	1730180092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANI JANE CABRERA DO

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:	208-381-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 NW 11TH ST
Second Line	:
City	:	FRUITLAND
State	:	ID
Zip	:	83619-2255
Country	:	US
Telephone Number	:	208-452-8700
Fax Number	:	208-452-8725

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/17/2013

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