Individual
DR. JENNIFER NICOLE LILLEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 E IDAHO ST STE 304, BOISE, ID 83712
(208) 381-7040
Mailing address
100 E IDAHO ST STE 304, BOISE, ID 83712-6269
(208) 381-7040
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD177334
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2012
Last updated
05/15/2019
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