Individual
TRACI H PERMENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
303 N ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 888-5848
Mailing address
PO BOX 16303, BOISE, ID 83715-6303
(713) 858-1040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1717
ID
Other
Enumeration date
04/15/2019
Last updated
11/18/2020
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