Individual
MICHAEL BENJAMIN JARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2020 S EAGLE RD, MERIDIAN, ID 83642-6707
(208) 518-0797
Mailing address
2231 S COLORADO AVE, BOISE, ID 83706-4625
(209) 598-0092
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
60757
ID
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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