NPI 1003992140

Jenny Rickell Willmore, PAC

Practitioner Physician Assistant Saint Anthony, ID

Practice location

Address: 605 Maple Ave, Saint Anthony, ID 83445-5529
Phone: (208) 624-4002
Fax: (208) 624-4409

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-519 (ID)

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Registry record

NPI: 1003992140
Entity type: Individual
Sex (as registered): Female
NPI issued: 31 Oct 2006
Record last updated: 25 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.