Individual provider · NPI-1

Jacob Chamberlain, RN

Registered Nurse, General Practice · Boise, ID

NPI number1053045153
StatusActive
Last updated in NPPESJul 13, 2022

Details

NPI
1053045153
Entity type
Individual (NPI-1)
Name
Jacob Chamberlain
Credential
RN
Sex
Male
Sole proprietor
Yes
Enumeration date
Jul 13, 2022
Certification date
Jul 13, 2022
Last updated
Jul 13, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WG0000X Registered Nurse, General Practice71945IDYes

Practice location

500 W Fort St
Boise, ID 83702-4599

Phone 208-422-1000

Mailing address

500 W Fort St
Boise, ID 83702-4599

Phone 208-422-1000

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