NPI age
14 years
Enumerated 2011-09-12
Across 97 active physician assistant providers in Idaho.
3 secondary locations on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | PA21747 | PA LICENSE |
Part of a multi-provider practice. 6 other active providers share this practice address in NPPES.
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