Provider Demographics
NPI:1861689655
Name:STIREMAN, JENNY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:ANN
Last Name:STIREMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANN
Other - Last Name:ROBESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:100 HOSPITAL DR.
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340
Mailing Address - Country:US
Mailing Address - Phone:208-727-8600
Mailing Address - Fax:208-727-8601
Practice Address - Street 1:100 HOSPITAL DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-727-8600
Practice Address - Fax:208-727-8601
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-838A363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1341055Medicare PIN