Individual
BRANDY RENEE' JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(509) 552-5641
Mailing address
10545 W CAROLINA DR, BOISE, ID 83709-2495
(509) 552-5641
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
08/29/2022
Last updated
08/29/2022
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