Individual
JENIFER SHANON CONN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1510 12TH AVENUE RD STE 200, NAMPA, ID 83686
(208) 302-0600
(208) 302-0755
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-0600
(208) 302-0755
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
N32302
ID
363LA2200X
Adult Health Nurse Practitioner
Primary
60035
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60035
APRN-CNP
ID
01
—
N32302
N32302
ID
Enumeration date
10/19/2010
Last updated
07/03/2019
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