NPI age
12 years
Enumerated 2013-06-14
Across 1263 active physician assistant providers in Idaho.
2 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (WY) | PA873 | STATE |
| 01 (ID) | 83-3011825 | STATE |
| 01 (ID) | PA-1551 | STATE |
Part of a multi-provider practice. 18 other active providers share this practice address in NPPES.
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