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Individual

AMANDA BLANCHET

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
3080 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3013

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1689
ID
363A00000X
Physician Assistant

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1152171
NCCPA
Enumeration date
09/28/2018
Last updated
06/23/2023
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