NPI age
8 years
Enumerated 2017-12-14
Across 1263 active physician assistant providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | PA-1683 | ID LICENSE |
| 01 (MA) | PA6337 | MA LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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