Individual
ALISON R DEKERCHOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3101 E STATE ST STE 1100, EAGLE, ID 83616-6232
(208) 473-3500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1837
ID
Other
Enumeration date
12/06/2019
Last updated
11/08/2023
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