Individual
JADE DARDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-7101
Mailing address
30410 HIGHWAY 200, PONDERAY, ID 83852-9601
(208) 263-7101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-13138
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M-13138
STATE MEDICAL LICENSE
ID
Enumeration date
06/30/2014
Last updated
12/27/2017
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