Individual
MARY FISK MEBANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-7539
(208) 381-6400
(208) 381-6450
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
RPA250
ID
Other
Enumeration date
05/18/2006
Last updated
08/18/2012
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