Individual
KADEN J THUESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 298-1022
(208) 746-8741
Mailing address
320 WARNER DR, LEWISTON, ID 83501-4441
(208) 298-1022
(208) 746-8741
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-1272
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679941553
—
ID
05
—
1679941553
—
WA
Enumeration date
09/09/2015
Last updated
06/24/2016
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