Breeann Marie Petrie PA-C

NPI 1235430059 - Physician Assistant - 363A00000X

NPI Details
NPI 1235430059
Gender Female
Enumeration Date 11/10/2010
Last Updated 11/10/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
1102 E LOCUST ST
EMMETT ID, 83617-2713, US
Phone (208) 365-6004
Fax (208) 365-3589
Business Location
1102 E LOCUST ST
EMMETT ID, 83617-2713, US
Phone (208) 365-6004
Fax (208) 365-3589
Toxanomy
Taxonomy Code 363A00000X
License State Idaho
License Number PA875
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According to our database, Breeann Marie Petrie PA-C NPI is 1235430059, taxonomy code is 363A00000X and license number is PA875, license state is located at Idaho. Breeann Marie Petrie PA-C physically located at 1102 E Locust St, Emmett ID, 83617-2713. NPI Number Breeann Marie Petrie PA-C has the Individual type.

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1235430059 NPI number is provided on an as is basis without warranty of any kind. 1235430059 is maintained by the National Plan & Provider Enumeration System. The contents of Breeann Marie Petrie PA-C are for informational purposes only.