Individual
MISTY NEISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(208) 381-2711
(208) 381-4025
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1189
ID
Other
Enumeration date
02/10/2015
Last updated
03/28/2022
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