Provider Demographics
NPI:1225396211
Name:LESSO, JENNIFER CARRIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CARRIE
Last Name:LESSO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:CARRIE
Other - Last Name:NEWHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1345
Mailing Address - Country:US
Mailing Address - Phone:208-983-1700
Mailing Address - Fax:208-983-4665
Practice Address - Street 1:607 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1345
Practice Address - Country:US
Practice Address - Phone:208-983-1700
Practice Address - Fax:208-983-4665
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-33959163W00000X
IDNP-1366A207Q00000X, 363L00000X
TNRN0000189495163W00000X
TNAPN0000016812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily