Individual
MRS. JEANNA RAE RENDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
811 NW 12TH ST, FRUITLAND, ID 83619-2268
(208) 452-7450
Mailing address
233 E NORTH ST, GRANGEVILLE, ID 83530-1838
(208) 695-6668
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60528
ID
363LG0600X
Gerontology Nurse Practitioner
60528
ID
Other
Enumeration date
01/18/2020
Last updated
02/07/2025
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