Individual
STEPHANIE DALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6565 W EMERALD ST, BOISE, ID 83704-8737
(208) 377-5055
(208) 377-5335
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA374
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806165300
—
ID
Enumeration date
10/19/2006
Last updated
10/04/2022
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