Individual
MRS. KATIE DIANA WAITES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-6528
(208) 381-4210
(208) 381-2045
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1501
ID
Other
Enumeration date
03/26/2007
Last updated
04/04/2025
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