Provider Demographics
NPI:1770594020
Name:QUICK, JENNIFER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 W NORTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7126
Mailing Address - Country:US
Mailing Address - Phone:208-327-0504
Mailing Address - Fax:208-327-0594
Practice Address - Street 1:8050 NORTHVIEW ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7126
Practice Address - Country:US
Practice Address - Phone:208-327-0504
Practice Address - Fax:208-327-0594
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 568A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806614700Medicaid
IDP85483Medicare UPIN
ID1344010Medicare ID - Type Unspecified