Individual
JILLIAN SOPHIA WITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, AGACNP-BC
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-3971
(208) 381-2566
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
75738
ID
Other
Enumeration date
11/06/2023
Last updated
01/08/2024
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