Individual
JESSICA ELAINE FU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
315 ELM STREET, STE 310, CALDWELL, ID 83605
(208) 454-2035
(208) 454-1065
Mailing address
315 ELM STREET, STE 310, CALDWELL, ID 83605
(208) 454-2035
(208) 454-1065
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M-11303
ID
390200000X
Student in an Organized Health Care Education/Training Program
LL1756
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL1756
NV MEDICAL LIC
NV
Enumeration date
07/06/2007
Last updated
08/07/2014
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