Individual
MRS. JENNIFER ANN HACKWITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 W FORT ST # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1319
Mailing address
500 W FORT ST # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APN000808
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307861
—
AZ
Enumeration date
05/06/2006
Last updated
02/25/2022
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