Individual
KATHLEEN ANNEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1072 N LIBERTY ST STE 100, BOISE, ID 83704-8708
(208) 302-1200
(208) 302-1255
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-378
ID
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
PA-378
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806217300
—
ID
Enumeration date
04/10/2007
Last updated
02/27/2024
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