NPI age
17 years
Enumerated 2008-10-01
Across 1263 active physician assistant providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 808211700 | |
| 05 (ID) | 808211701 | |
| 05 (ID) | 808211702 | |
| 01 (ID) | 012345 | LICENSE PENDING |
Part of a multi-provider practice. 23 other active providers share this practice address in NPPES.
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