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Contact Information

JACLYN G MENTZER, PA
388 E. PARKCENTER BLVD. GEM STATE DERMATOLOGY
BOISE, ID83706
 Phone: 208-424-9101
 Fax: 208-424-5072
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for JACLYN G MENTZER · (Female)

NPI Number 1487899365
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 12/08/2008
Last updated 01/27/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M7247
  • ID License # PA-773
  • ID License # PA773
  • ID Medicaid 808380800
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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