Provider Demographics
NPI:1730608688
Name:GERE, JENNA LINDSAY (PNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LINDSAY
Last Name:GERE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4236
Mailing Address - Country:US
Mailing Address - Phone:208-921-1488
Mailing Address - Fax:
Practice Address - Street 1:417 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7632
Practice Address - Country:US
Practice Address - Phone:208-577-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner