Individual
AMY S WASELCHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
600 N ROBBINS RD, STE 100, BOISE, ID 83702-4566
(208) 383-0201
(208) 489-4300
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PRA-147
ID
Other
Enumeration date
08/08/2006
Last updated
09/19/2012
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