Individual
LISA A BOSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1951 BENCH RD STE B, POCATELLO, ID 83201-2073
(208) 238-1000
Mailing address
1951 BENCH RD, POCATELLO, ID 83201-2013
(208) 239-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-692
ID
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807835100
—
ID
Enumeration date
08/22/2007
Last updated
02/14/2024
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