Individual
MRS. JENNIFER RENEE MACDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RN, ACNS-BC
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
(208) 381-1873
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
60641
ID
363LA2200X
Adult Health Nurse Practitioner
APRN.CNP.12917
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0194314
—
OH
Enumeration date
07/02/2010
Last updated
08/24/2023
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