Individual
NATHAN JOHN CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6052 W STATE ST, BOISE, ID 83703-2739
(208) 344-7799
(208) 344-7152
Mailing address
6052 W STATE ST, BOISE, ID 83703-2739
(208) 344-7799
(208) 344-7152
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-266
ID
363AM0700X
Medical Physician Assistant
Primary
PA-266
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-266
STATE LISCENSE
ID
01
—
PA00678
OR STATE LISCENSE
OR
Enumeration date
11/02/2005
Last updated
11/01/2023
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