Individual
JACOB WAYDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 W CHINDEN BLVD, MERIDIAN, ID 83646-6690
(208) 809-2860
(208) 809-2861
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
76016
ID
Other
Enumeration date
01/17/2024
Last updated
03/20/2025
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