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Individual

JENNIFER PETRIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-7131
(208) 365-4464
Mailing address
2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-7131
(208) 365-4464

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
101703
MN
207Q00000X
Family Medicine Physician
Primary
M7802
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01-20325
MEDICA CHOICE
MN
05
0591172
IA
01
1043689
PREFERRED ONE
MN
01
136314
UCARE
MN
01
20008330
PTAN
ID
01
2349340
ARAZ
MT
05
317180900
MN
05
34623200
WI
05
8051964
ID
01
HP51751
HEALTH PARTNERS
MN
Enumeration date
10/24/2006
Last updated
02/23/2016
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