Individual
MRS. LISA M WILKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
444 W FORT ST FL 2, BOISE, ID 83702-4535
(208) 422-1018
Mailing address
444 W FORT ST FL 2, BOISE, ID 83702-4535
(208) 422-1018
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2140
ID
363AM0700X
Medical Physician Assistant
PA05035
TX
Other
Enumeration date
08/01/2006
Last updated
08/31/2023
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