Individual
RENAE RAMOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1032 S BRIDGEWAY PL, EAGLE, ID 83616-6099
(208) 246-0123
Mailing address
1032 S BRIDGEWAY PL, EAGLE, ID 83616-6099
(208) 246-0123
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
PA-1856
ID
363AM0700X
Medical Physician Assistant
Primary
PA-1856
ID
Other
Enumeration date
02/05/2020
Last updated
08/11/2023
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