Provider Demographics
NPI:1790370765
Name:IDAHO NP CLINIC PLLC
Entity Type:Organization
Organization Name:IDAHO NP CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-901-7006
Mailing Address - Street 1:1883 WILDWOOD ST STE C
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5146
Mailing Address - Country:US
Mailing Address - Phone:208-901-7006
Mailing Address - Fax:
Practice Address - Street 1:1883 WILDWOOD ST STE C
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5146
Practice Address - Country:US
Practice Address - Phone:662-571-7651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty