Individual
MARY ANN TUTHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6533 W EMERALD ST, BOISE, ID 83704-8737
(208) 367-4170
(208) 367-8135
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-13
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001493100
—
ID
Enumeration date
06/11/2006
Last updated
01/05/2009
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