Individual
TALIA M SIERRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3217 W BAVARIA STREET, EAGLE, ID 83616
(208) 286-6676
(208) 947-3419
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 286-6676
(208) 947-3419
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-768
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629228978
—
ID
01
—
PA-768
IDAHO BOARD OF MEDICINE
ID
Enumeration date
09/23/2008
Last updated
02/25/2022
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