Individual
RYANN LYNN LAGOMARSINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 N 1ST ST STE 240, BOISE, ID 83702-6132
(208) 338-8900
(208) 947-1190
Mailing address
333 N 1ST ST STE 240, BOISE, ID 83702-6132
(208) 338-8900
(208) 947-1190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2013
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
09/09/2019
Last updated
02/08/2021
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