Provider Demographics
NPI:1821485012
Name:MIMISH, JENNIFER JEAN (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:MIMISH
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:NAVARRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHNP
Mailing Address - Street 1:1301 S MILLSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-4837
Mailing Address - Country:US
Mailing Address - Phone:208-559-6494
Mailing Address - Fax:
Practice Address - Street 1:1301 S MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-4837
Practice Address - Country:US
Practice Address - Phone:208-352-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-25
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1553A364SW0102X, 363L00000X
IDCNM84A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife