Individual
MS. HEATHER LEA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
209 FOREST ST, MCCALL, ID 83638-5256
(208) 634-1776
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1144
ID
363A00000X
Physician Assistant
PA2008-0013
NM
Other
Enumeration date
06/14/2006
Last updated
11/09/2021
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