Individual
BRYAN WAYNE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9850 W ST LUKES DR STE 260, NAMPA, ID 83687-7912
(208) 381-6930
(208) 381-6931
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1071708
GA
363A00000X
Physician Assistant
Primary
PA-2055
ID
Other
Enumeration date
07/31/2006
Last updated
12/03/2024
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