Provider Demographics
NPI:1588772461
Name:CREASER, JENNIFER C (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:CREASER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-0341
Mailing Address - Country:US
Mailing Address - Phone:208-848-9001
Mailing Address - Fax:208-848-9002
Practice Address - Street 1:2841 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4719
Practice Address - Country:US
Practice Address - Phone:208-848-9001
Practice Address - Fax:208-848-9002
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1021A363L00000X
WAAP30006968363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1014089Medicaid
ID1588772461OtherREGENCE BLUESHIELD
IDP00884066OtherRR MEDICARE
IDNP733OtherBC/ID
WA1014089Medicaid
WA0270668OtherLABOR & INDUSTRIES
ID1588772461Medicaid
ID1349095Medicare PIN