Individual
LAURA POLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 W FORT ST # 111, BOISE, ID 83702-4599
(208) 422-1325
(208) 422-1319
Mailing address
500 W FORT ST # 111, BOISE, ID 83702-4599
(208) 422-1325
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-895
ID
Other
Enumeration date
03/28/2011
Last updated
02/25/2022
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