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Individual

MS. TESSA POULSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
325 MARTIN ST, TWIN FALLS, ID 83301-4563
(208) 734-0451
(208) 734-0452
Mailing address
1404 POMERELLE AVE, STE B, BURLEY, ID 83318-2013
(208) 734-3312
(208) 734-5036

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1002
ID
363A00000X
Physician Assistant
PA21275
CA
363A00000X
Physician Assistant
ID

Other

Enumeration date
10/25/2010
Last updated
12/07/2016
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