Most Relevant Information
Provider Data
| NPI Number: | 1003409913 |
| Provider Name: | JENNIFER LYTLE FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 67384 |
Most Important Dates
| Enumeration Date: | 02/11/2021 |
| Last Updated: | 09/02/2021 |
Provider Practice Location
3280 E LANARK DR
MERIDIAN
ID
836425982
Practice Location Phone/Fax
| Phone: | 2088958670 |
| Fax: | 2089550494 |
Provider Mailing Location
PO BOX 191050
BOISE
ID
837191050
Provider Mailing Phone/Fax
| Phone: | 2089851399 |
| Fax: |