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Organization
IDAHO COUNTY DERMATOLOGY, PLLC
Active
Organization
IDAHO COUNTY DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNA RENDO NP-C (OWNER/PROVIDER)
(208) 695-6668
Entity
Organization
Contact information
Practice address
113 S A ST, GRANGEVILLE, ID 83530-1428
(208) 695-6668
Mailing address
113 S A ST, GRANGEVILLE, ID 83530-1428
(208) 717-4940
(208) 717-4990
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/16/2024
Last updated
02/07/2025
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