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Individual
VINCENT FIBELSTAD
Active
Individual
VINCENT FIBELSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-02
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10017689
REGENCE OF ID URGENT CARE
ID
01
—
10017690
REGENCE OF IDAHO
ID
05
—
8118705
—
WA
01
—
HBNA1
IDAHO BLUE CROSS
ID
Enumeration date
02/02/2007
Last updated
07/09/2007
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