Individual
MARY HOLLOWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6051 W EMERALD ST, BOISE, ID 83704-8969
(208) 302-5150
(208) 302-5155
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2706
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/14/2022
Last updated
10/29/2024
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