Individual
AMBER ANN HACKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
323 E RIVERSIDE DRIVE, STE 224, EAGLE, ID 83616
(208) 302-6000
(208) 302-6055
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642
(208) 302-6000
(208) 302-6055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-948
ID
363A00000X
Physician Assistant
PA152970
OR
Other
Enumeration date
09/29/2010
Last updated
02/15/2018
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