Provider Demographics
NPI:1679931224
Name:AL JAF, SHWAN
Entity Type:Individual
Prefix:
First Name:SHWAN
Middle Name:
Last Name:AL JAF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 W FAIRVIEW AVE
Mailing Address - Street 2:APT 207
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8585
Mailing Address - Country:US
Mailing Address - Phone:208-918-7259
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST
Practice Address - Street 2:SUITE 209
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1966
Practice Address - Country:US
Practice Address - Phone:208-918-7259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDW159670163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health