Provider Demographics
NPI:1023386919
Name:VAN HORN, JENNIFER L (AOCNS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:AOCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-463-5000
Mailing Address - Fax:208-375-2217
Practice Address - Street 1:2000 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-820-4351
Practice Address - Fax:970-810-3897
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY29968.1138364SX0200X
COAPN.0995749-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1023386919Medicaid
W24535Medicare PIN