Individual
MRS. JENNICE M CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 S 1ST AVE E, MIDDLETON, ID 83644-5809
(208) 585-6311
(208) 585-6221
Mailing address
2165 ASPEN COVE DR, MERIDIAN, ID 83642-6517
(208) 288-2548
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-281
ID
Other
Enumeration date
01/20/2006
Last updated
02/12/2008
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