Individual
GRETCHEN G BASEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
775 POLE LINE RD W, SUITE 115, TWIN FALLS, ID 83301-5814
(208) 814-8150
(208) 732-3112
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 928-7773
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-914
ID
363AS0400X
Surgical Physician Assistant
C0001509
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861549396
—
ID
Enumeration date
01/05/2007
Last updated
04/14/2014
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