Individual
MARIAH EMILY MCREYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2511
ID
363A00000X
Physician Assistant
PA55182
CA
Other
Enumeration date
10/25/2017
Last updated
10/05/2023
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