Organization
KEYSTONE CENTER FOR GERIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD RICHARD JENSEN FNP-C (OWNER)
(208) 514-0670
Entity
Organization
Contact information
Practice address
305 W BANNOCK ST, BOISE, ID 83702-6033
(208) 514-0670
Mailing address
305 W BANNOCK ST, BOISE, ID 83702-6033
(208) 514-0670
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
09/03/2021
Last updated
09/03/2021
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