Individual
LOUISSA CAROLYN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
121 E FORT ST, BOISE, ID 83712-6322
(208) 514-2525
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1772
ID
363A00000X
Physician Assistant
PA60549072
WA
Other
Enumeration date
04/10/2015
Last updated
08/22/2019
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