Organization
NEONATAL ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON JENKINS D.O. (MANAGER)
(208) 529-7165
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-7165
Mailing address
3270 E 17TH ST # 207, AMMON, ID 83406-6758
(208) 529-7165
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
0-0424
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807241000
—
ID
05
—
808012100
—
ID
05
—
8080270
—
ID
Enumeration date
11/12/2008
Last updated
11/12/2008
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