Individual
MISS CHANTELLE E BOWMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
717 MISSION ROAD, COMMUNITY HEALTH NURSING PROGRAM, FORT HALL, ID 83203
(208) 238-5435
(208) 238-5440
Mailing address
PO BOX 306, FORT HALL, ID 83203-0306
(208) 234-2300
(208) 234-0026
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-831
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA831
IDAHO BOARD OF MEDICINE
ID
Enumeration date
12/02/2009
Last updated
03/29/2016
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