Individual
ELLI FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3399 E LOUISE DR STE 100, MERIDIAN, ID 83642-5212
(208) 887-6813
(208) 887-6884
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2345
ID
Other
Enumeration date
06/10/2022
Last updated
10/09/2023
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