Individual
MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
8854 W EMERALD ST, BOISE, ID 83704-4844
(208) 321-4790
Mailing address
8854 W EMERALD ST, BOISE, ID 83704-4844
(208) 321-4790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/25/2023
Last updated
05/21/2026
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