Individual
STEPHANIE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
113 S APPLE ST, SHOSHONE, ID 83352-5287
(208) 886-2224
Mailing address
PO BOX 609, SHOSHONE, ID 83352-0609
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA637
ID
Other
Enumeration date
11/16/2006
Last updated
03/13/2008
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