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Individual

JOHN DUSTIN PENA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
403 RIVERFRONT DR, SALMON, ID 83467-5162
(208) 742-1110
(208) 742-1120
Mailing address
403 RIVERFRONT DR, SALMON, ID 83467-5162
(208) 742-1110

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
65855
ID

Other

Enumeration date
10/14/2020
Last updated
10/08/2024
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