Individual
JENNIFER KATHRYN LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-13350
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356784201
—
ID
Enumeration date
04/10/2013
Last updated
07/12/2016
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