Individual
LAUREN MOAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-5651
(208) 706-5344
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1271985
ID
Other
Enumeration date
08/07/2023
Last updated
11/11/2025
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