Individual
A TERESA GABIOLA SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704-8969
(208) 302-5150
(208) 302-5155
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-8550
(208) 367-8555
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
8075898-1206
UT
363AM0700X
Medical Physician Assistant
Primary
PA-1091
ID
Other
Enumeration date
09/13/2011
Last updated
12/30/2022
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