Individual
MRS. JENNIFER CARRIE LESSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-1700
(208) 983-4665
Mailing address
607 W MAIN ST, GRANGEVILLE, ID 83530-1345
(208) 983-1700
(208) 983-4665
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-33959
ID
207Q00000X
Family Medicine Physician
NP-1366A
ID
363L00000X
Nurse Practitioner
Primary
NP-1366A
ID
Other
Enumeration date
04/26/2012
Last updated
11/18/2020
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