Individual
BROOKE LEE SKINNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
110 VISTA DR, POCATELLO, ID 83201-5824
(208) 234-2300
Mailing address
4728 REVOLUTION RD, CHUBBUCK, ID 83202-1986
(208) 251-8700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2154
ID
Other
Enumeration date
11/24/2021
Last updated
12/18/2021
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