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Individual

MS. DEBRA ALICE MABBUTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.; PA-C

Contact information

Practice address
6000 WEST OVERLAND ROAD, BOISE, ID 83709-3013
(208) 323-7588
(206) 202-8007
Mailing address
6000 WEST OVERLAND ROAD, BOISE, ID 83709-3013
(208) 323-7588
(206) 202-8007

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M2852
ID
207Q00000X
Family Medicine Physician
M6006
ID
363A00000X
Physician Assistant
PA433
ID
363AM0700X
Medical Physician Assistant
PA-433
ID

Other

Enumeration date
09/21/2006
Last updated
12/30/2009
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