Provider Demographics
NPI:1134933450
Name:POND, JOANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:POND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 TAWZER WAY
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4944
Mailing Address - Country:US
Mailing Address - Phone:209-872-0707
Mailing Address - Fax:
Practice Address - Street 1:1547 MIDWAY AVE
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6912
Practice Address - Country:US
Practice Address - Phone:209-872-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9771645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily