Individual
MRS. MARY WELBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
190 E BANNOCK ST FL 10, BOISE, ID 83712-6241
(208) 381-5500
(208) 381-2555
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/07/2023
Last updated
11/04/2025
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