Doctor Name: | JESSICA ELAINE FU |
NPI Number: | 1710185111 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | LL1756 |
Business Practice Address: | 315 Elm Street Ste 310 Caldwell, ID - 83605 |
Business Phone Number: | 2084542035 |
Business Fax Number: | 2084541065 |
Mailing Address: | 315 Elm Street, Ste 310 CALDWELL |
State: | ID |
Postal Code: | 83605 |
Phone Number: | 2084542035 |
Fax Number: | 2084541065 |
NPI Enumeration Date: | 07/06/2007 |
NPI Last Update Date: | 08/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | LL1756 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NV |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |