Provider Demographics
NPI:1104089556
Name:BITTERS, J'CINDA J'NAE (MD)
Entity type:Individual
Prefix:MISS
First Name:J'CINDA
Middle Name:J'NAE
Last Name:BITTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:J'CINDA
Other - Middle Name:J'NAE
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 E LOGAN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4882
Mailing Address - Country:US
Mailing Address - Phone:208-459-4667
Mailing Address - Fax:208-459-3372
Practice Address - Street 1:211 E LOGAN ST STE 301
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4882
Practice Address - Country:US
Practice Address - Phone:208-459-4667
Practice Address - Fax:208-459-3372
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-10839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808082600Medicaid