Individual
BROOKELLE SMITH GUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
880 W QUINN RD, CHUBBUCK, ID 83202-2454
(208) 238-2000
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-2451
ID
Other
Enumeration date
06/03/2022
Last updated
02/21/2024
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