MRS. JACLYN GOLUS MENTZER (NPI# 1487899365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487899365 |
| Entity Type | Individual |
| Full Name | MRS. JACLYN GOLUS MENTZER |
| Credential | P.A. |
| Practice Address |
388 E. Parkcenter Blvd. Gem State Dermatology Boise ID 83706 |
| Practice Telephone | 2084249101 |
| Practice Fax Number | 2084245072 |
| Mailing Telephone | 2084249101 |
| Mailing Fax Number | 2084245072 |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2020-01-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | M7247 | ID | Allopathic & Osteopathic Physicians |
| N | 363A00000X | Physician Assistant | PA773 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363A00000X | Physician Assistant | PA-773 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 808380800 | 05 |
| Street Address |
388 E. PARKCENTER BLVD. GEM STATE DERMATOLOGY |
| City | BOISE |
| State | ID |
| Zip Code | 83706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164993010 | Brette Marie Stephenson | Counselor | 1529 Belmont St., Boise, ID 83706 | 2018-12-17 |
| 1295249241 | Boise of Cascadia, LLC | Skilled Nursing Facility | 6000 W. Denton St., Boise, ID 83706 | 2017-11-29 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1740708965 | Total Renal Care Inc | Clinic/Center | 1070 N Curtis Rd Ste 125, Boise, ID 83706 | 2017-09-08 |
| 1023532173 | Amber Frisch | Massage Therapist | 2509 S Gekeler Lane, Boise, ID 83706 | 2017-07-31 |
| 1952768145 | Katie Garcin | Specialist | 1407 E Boston Dr, Boise, ID 83706 | 2016-01-20 |
| 1770950677 | Kathryn Bender | Counselor | 1205 N Garden St, Boise, ID 83706 | 2015-08-26 |
| 1457751802 | Sabrina Shumar | Physician Assistant | 901 N Curtis Rd Ste 501, Boise, ID 83706 | 2014-09-03 |
| 1831525070 | Katie Joy Wilson | Social Worker | 333 W. Rossi St. #300, Boise, ID 83706 | 2013-09-19 |
| 1609208610 | Christine Lea Eden | Surgery | 1075 N Curtis Rd Ste 101, Boise, ID 83706 | 2013-07-31 |
| Find all providers in zip 83706 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821695792 | Chelsea Dylan Tennent | Physician Assistant | 1666 E Gentlewind St, Boise, ID 83706-5914 | 2020-10-05 |
| 1871114553 | Samantha Tess Goodrich | Physician Assistant | 721 E Lenz St, Boise, ID 83712-7846 | 2020-05-04 |
| 1689131005 | Aftin Jade Martens | Physician Assistant | 303 N Allumbaugh St, Boise, ID 83704-9208 | 2019-02-21 |
| 1215418140 | Michael Edward Molnar | Physician Assistant | 2012 S Longmont Ave, Boise, ID 83706-4235 | 2018-08-28 |
| 1578059143 | Mckenzie Hart | Physician Assistant | 4334 S Aleut Way, Boise, ID 83709-6033 | 2018-07-07 |
| 1174035638 | Zacharia Njoroge | Physician Assistant | 1055 N Curtis Rd 6th Floor, Boise, ID 83706 | 2017-10-24 |
| 1073040242 | Nicole Ankenbrandt | Physician Assistant | 3151 S Terra Dr, Boise, ID 83709-3831 | 2017-05-17 |
| 1346792033 | Samantha Rae Lange | Physician Assistant | 1072 N Liberty St Ste 203, Boise, ID 83704 | 2016-10-27 |
| 1174070098 | Alexandra W Clapp | Physician Assistant | 6140 West Curtisian Avenue Suite 200, Boise, ID 83704 | 2016-09-08 |
| 1376914838 | Morgan Grace Roskelley | Physician Assistant | 703 S. Americana Blvd, Ste 120, Boise, ID 83702 | 2015-10-09 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.