Individual
JENNIFER SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
932 E 113 N, IDAHO FALLS, ID 83401-5119
(208) 970-4079
Mailing address
932 E 113 N, IDAHO FALLS, ID 83401-5119
(208) 970-4079
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
51454
ID
163WN1003X
Nutrition Support Registered Nurse
51454
ID
Other
Enumeration date
10/10/2022
Last updated
10/10/2022
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