Individual
RYAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1623 S WELLS AVE, MERIDIAN, ID 83642-5040
(208) 489-1450
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1341
ID
Other
Enumeration date
01/19/2016
Last updated
06/16/2022
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