Audra Lynn Wilson, PAC
Physician Assistant in Boise, ID. Individual provider (NPI-1).
NPI number1336734789
StatusActive
Last updated in NPPESDec 10, 2024
Details
- NPI
- 1336734789
- Entity type
- Individual (NPI-1)
- Name
- Audra Lynn Wilson
- Credential
- PAC
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 8, 2021
- Certification date
- Dec 10, 2024
- Last updated
- Dec 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 1661274 | ID | Yes |
| 363A00000X | Physician Assistant | PA61338060 | WA | |
| 363AS0400X | Physician Assistant, Surgical | PA61338060 | WA |
Practice location
6140 W Curtisian Ave Ste 400Boise, ID 83704-8907
Phone 208-327-5600 · Fax 208-327-5602
Mailing address
6140 W Curtisian Ave Ste 400Boise, ID 83704-8907
Phone 208-327-5600 · Fax 208-327-5602
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