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Individual

CARLY SIENNA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
100 E IDAHO ST STE 302, BOISE, ID 83712-6269
(208) 343-7501
(208) 336-8248
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8866

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
363AM0700X
Medical Physician Assistant
Primary
1202198
ID
363AM0700X
Medical Physician Assistant
Primary
PA-2349
ID

Other

Enumeration date
06/10/2022
Last updated
03/02/2026
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