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Individual

MRS. MONICA J NEALIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1550 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 529-5942
(208) 529-5951
Mailing address
1550 ELK CREEK DR, IDAHO FALLS, ID 83404-8322
(208) 528-7320
(208) 529-5951

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
RPA-214
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010017186
BLUE SHIELD OF IDAHO
ID
05
805023600
ID
01
PAIN1
BLUE CROSS OF IDAHO
ID
Enumeration date
12/19/2006
Last updated
04/20/2017
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