Individual
CALI J BRADBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4750 N FIVE MILE RD, BOISE, ID 83713-2715
(208) 375-0500
(208) 375-4310
Mailing address
5985 W STATE ST, BOISE, ID 83703-3039
(208) 853-0071
(208) 853-9422
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
PA-937
ID
363A00000X
Physician Assistant
PA-937
ID
363AM0700X
Medical Physician Assistant
Primary
PA-937
ID
Other
Enumeration date
10/05/2011
Last updated
02/06/2023
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