Jennifer Mahlberg-Grant, APRN

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

53418 Issued in ID

Practice address

951 E Plaza Dr
Ste 110
Eagle, ID 83616-6567

Phone

(775) 738-5850

Fax

(775) 738-5856

NPI assigned

Jul 13, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1982126686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 E PLAZA DR",
            "address_2": "STE 110",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166567",
            "telephone_number": "775-738-5850",
            "fax_number": "775-738-5856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHLBERG-GRANT",
        "first_name": "JENNIFER",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-13",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "ID",
            "license": "53418",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "APRN002287",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LICENSE",
            "identifier": "APRN002287",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marion Lynn Luque, M.D.
• Rosalie Jane Lynch, LCPC, LMHC, CMHC
• Matthew R Macha, MD
• Rayven Macnab
• Kristin Adrianne Mahaffey, MFT-C
• Melissa Major, NP-C
• Mallory Murphy
• Nancy Mallory, MD
• Kirsten Malmendier, LICENSED ACUPUNCTURI
• Jennifer Maltby, D.C.

• Women's Health Nurse Practitioner in Eagle, ID
• Providers in Eagle, ID by specialty
• Women's Health Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.