Individual
LOGAN MAKAYLA HAWKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1906 S VISTA AVE, BOISE, ID 83705-3453
(503) 554-2521
Mailing address
1066 S SILVERSTONE WAY APT C230, MERIDIAN, ID 83642-1365
(541) 212-3842
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/18/2023
Last updated
02/26/2025
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