Individual
JAY PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 SHOUP AVE W, TWIN FALLS, ID 83301-5028
(209) 996-1700
Mailing address
604 LYNWOOD BLVD, TWIN FALLS, ID 83301-4133
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3561779
ID
Other
Enumeration date
09/25/2024
Last updated
09/25/2024
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