Individual
MISS AUTUMN L MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1319
Mailing address
2150 E STAR LN, MERIDIAN, ID 83646-5516
(208) 484-3740
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1632
—
Other
Enumeration date
08/16/2018
Last updated
03/16/2022
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