Individual
ELEANOR ROSE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 E IDAHO ST STE 302, BOISE, ID 83712-6269
(208) 343-7501
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2592
ID
Other
Enumeration date
06/27/2022
Last updated
07/28/2025
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