Most Relevant Information
Provider Data
| NPI Number: | 1003339268 |
| Provider Name: | JENNIFER WOODBURN |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | RN166862 |
Most Important Dates
| Enumeration Date: | 07/19/2017 |
| Last Updated: | 05/09/2022 |
Provider Practice Location
190 E BANNOCK ST
BOISE
ID
837126241
Practice Location Phone/Fax
| Phone: | 2083815015 |
| Fax: |
Provider Mailing Location
190 E BANNOCK ST
BOISE
ID
837126241
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |