Individual
JAYNE STEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
802 W BANNOCK ST, SUITE 405, BOISE, ID 83702-5837
(208) 336-7341
(208) 336-7342
Mailing address
802 W BANNOCK ST, SUITE 405, BOISE, ID 83702-5837
(208) 336-7341
(208) 336-7342
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
M8899
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147087
REGENCE BLUE SHIELD
ID
01
—
75739
BLUE CROSS OF IDAHO
ID
Enumeration date
02/21/2007
Last updated
07/08/2007
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