Individual
NICHOLE ROBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
10 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
(082) 656-9467
Mailing address
10 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
(082) 656-9467
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-310
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649693649
—
ID
Enumeration date
10/24/2006
Last updated
11/03/2021
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