Individual
EMILY GRACE BOND RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9850 W ST LUKES DR # 329, NAMPA, ID 83687-7912
(208) 514-2509
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2563
ID
Other
Enumeration date
09/12/2019
Last updated
12/15/2023
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