Individual
SORCHA M CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 E JEFFERSON ST, STE 300, BOISE, ID 83712-6246
(208) 381-4000
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 732-3400
(208) 732-3300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA825
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA825
STATE LICENSE
ID
Enumeration date
10/29/2009
Last updated
01/05/2012
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