Individual
DR. JACKIE J WHITESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1072 N LIBERTY ST, SUITE 303, BOISE, ID 83704-2800
(208) 367-2800
(208) 367-7111
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M-11022
ID
Other
Enumeration date
03/26/2007
Last updated
04/23/2014
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