Dardine, Jade
Dardine, Jade is an sole proprietor health care provider with primary practice located at 30410 Highway 200 , Ponderay ID 83852-9601. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Dardine, Jade can be contacted via phone (208) 263-7101.Contact Information
Primary practice address
30410 Highway 200
Ponderay ID 83852-9601
Phone: (208) 263-7101
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M-13138 | Idaho |
Profile Details
| NPI number | 1720493638 |
|---|---|
| LBN Legal business name | Dardine, Jade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 30th, 2014 |
| Last updated | Dec 27th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720493638 | NPPES |
| Idaho | Other | M-13138 | STATE MEDICAL LICENSE |
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