Misty Neisen

NPI 1023409265 - Physician Assistant - 363A00000X

NPI Details
NPI 1023409265
Gender Female
Enumeration Date 02/10/2015
Last Updated 02/10/2015
Entity Type Individual
Active Over 1 year ago
Practice Location
125 E IDAHO ST
STE 303
BOISE ID, 83712-6212, US
Phone (208) 381-9350
Fax (208) 381-9351
Business Location
190 E BANNOCK ST
BOISE ID, 83712-6241, US
Phone (208) 381-2222
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Idaho
License Number PA1189
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According to our database, Misty Neisen NPI is 1023409265, taxonomy code is 363A00000X and license number is PA1189, license state is located at Idaho. Misty Neisen physically located at 125 E Idaho St, Boise ID, 83712-6212. NPI Number Misty Neisen has the Individual type.

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1023409265 NPI number is provided on an as is basis without warranty of any kind. 1023409265 is maintained by the National Plan & Provider Enumeration System. The contents of Misty Neisen are for informational purposes only.