Individual
MR. JESSE D VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(801) 641-6510
Mailing address
2537 W STATE ST STE 200, BOISE, ID 83702-2200
(801) 641-6510
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN.215484R
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
N-45970
ID
Other
Enumeration date
05/02/2013
Last updated
03/17/2018
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