MRS. JACLYN GOLUS MENTZER


Address: 388 E. Parkcenter Blvd. Gem State Dermatology, Boise, ID 83706
Phone: 2084249101

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
ID 808380800 05

Office Location

Street Address 388 E. PARKCENTER BLVD. GEM STATE DERMATOLOGY
City BOISE
State ID
Zip Code 83706

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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
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Competitor

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City BOISE
Zip Code 83706

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Dataset Information

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.

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