Individual
MS. GWEN AILEEN LINDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 W FORT ST, # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1053
Mailing address
500 W FORT ST, # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1053
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1060
ID
363A00000X
Physician Assistant
RPA-164
ID
Other
Enumeration date
09/26/2006
Last updated
04/27/2022
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