Individual
JENNIFER L PREUCIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2550 ADDISON AVE E, SUITE B, TWIN FALLS, ID 83301-6749
(208) 814-7700
(208) 933-9301
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7812
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805473400
—
ID
01
—
P00460913
MCRR
ID
Enumeration date
06/16/2006
Last updated
12/29/2014
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