Mentzer, Jaclyn Golus

Mentzer, Jaclyn Golus is an individual health care provider with primary practice located at 388 E. Parkcenter Blvd. Gem State Dermatology , Boise ID 83706. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Mentzer, Jaclyn Golus can be contacted via phone (208) 424-9101.

Contact Information

Primary practice address
388 E. Parkcenter Blvd. Gem State Dermatology Boise ID 83706
Phone: (208) 424-9101
Fax: (208) 424-5072
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X M7247 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA773 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-773 Idaho

Profile Details

NPI number 1487899365
LBN Legal business name Mentzer, Jaclyn Golus
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 8th, 2008
Last updated Jan 27th, 2020 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487899365 NPPES
Idaho MEDICAID 808380800

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