Organization
SOUTHERN IDAHO MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICCA MARIE CRISMOR FNP (OWNER)
(208) 308-7738
Entity
Organization
Contact information
Practice address
207 E MAIN ST, JEROME, ID 83338-2334
(208) 308-7738
Mailing address
137 WOODRIDGE DR, TWIN FALLS, ID 83301-8156
(208) 308-7738
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/26/2022
Last updated
12/26/2022
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