Individual
VITALIY NEBYSHINETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 463-3000
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
60502966
WA
363A00000X
Physician Assistant
Primary
PA-2179
ID
Other
Enumeration date
10/15/2014
Last updated
05/20/2024
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