Individual
KURT WIEBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Mailing address
6140 W CURTISIAN AVE STE 400, BOISE, ID 83704-8907
(208) 327-5600
(208) 327-5602
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2143
ID
Other
Enumeration date
10/14/2021
Last updated
01/17/2024
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