Jacob Chamberlain, RN
Individual provider Active NPI General Practice Registered Nurse · Boise, ID
NPI 1053045153 · NPPES record last updated Jul 13, 2022
Key facts
- NPI
- 1053045153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Registered Nurse 163WG0000X
- License
- 71945 (ID)
- Practice address
- 500 W Fort St
Boise, ID 83702-4599 - Phone
- (208) 422-1000
- NPI assigned
- Jul 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71945 | ID | MD | General Practice Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | 71945 | ID | Yes |
Addresses
Primary practice location
500 W Fort St
Boise, ID 83702-4599
Mailing address
500 W Fort St
Boise, ID 83702-4599
Phone (208) 422-1000
Other providers in Boise, ID
- Brian C Cey
- CH MH Services (Id), LLC
- Jack C Chaffin Jr.
- Karsyn Chalfa-Swift
- Melissa Jimenez Chalom
- Kathryn Chamberlain
- Sheri Chamberland
- Brian Chambers
- Brian Earl Chambers
- Chantal Brooke Chambers
All providers in Boise, ID · General Practice Registered Nurse in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.