Provider Demographics
NPI:1649764416
Name:JAHN, JENNIFER (CPM, LM, CHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JAHN
Suffix:
Gender:F
Credentials:CPM, LM, CHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 W ROSE HILL ST.
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1563
Mailing Address - Country:US
Mailing Address - Phone:208-450-5321
Mailing Address - Fax:
Practice Address - Street 1:3223 W ROSE HILL ST.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1563
Practice Address - Country:US
Practice Address - Phone:208-450-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM18178R176B00000X
IDMID-90176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife