Individual
MISS ANGHARAD SUPE LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
ISU STUDENT HEALTH CTR, 921 S. 8TH ST., POCATELLO, ID 83209-0001
(208) 282-2330
(208) 282-4036
Mailing address
69 FOOTHILL BLVD, POCATELLO, ID 83204-4063
(208) 282-2330
(208) 282-4036
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PA-365
ID
Other
Enumeration date
11/20/2006
Last updated
07/08/2007
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