Individual
MARC MANKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2235
(208) 381-4556
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1529
ID
363A00000X
Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/12/2017
Last updated
06/25/2024
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