Individual
BEATRIZ C.S. SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-653
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-653
IDAHO MEDICAL LICENSE #
ID
01
—
PAF84
BLUE CROSS OF IDAHO
ID
Enumeration date
03/06/2007
Last updated
03/04/2022
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