Provider Demographics
NPI:1437765344
Name:MAIRE, JENNIFER CHRISTINE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:MAIRE
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 S 25TH E # 1016
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-5710
Mailing Address - Country:US
Mailing Address - Phone:208-671-7013
Mailing Address - Fax:208-656-5652
Practice Address - Street 1:1999 S 25TH E # 1016
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-5710
Practice Address - Country:US
Practice Address - Phone:208-671-7013
Practice Address - Fax:208-932-4319
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1437765344363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty