Individual
GAYLE JEAN DETWEILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
366 SW 5TH AVE, SUITE 100, MERIDIAN, ID 83642-8600
(208) 898-9755
(208) 898-2544
Mailing address
366 SW 5TH AVE, SUITE 100, MERIDIAN, ID 83642-8600
(208) 898-9755
(208) 898-2544
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA263
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PAC53
BLUE CROSS OF IDAHO
ID
Enumeration date
11/07/2006
Last updated
07/09/2007
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