Individual
SAMANTHA TESS GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3248 S CADET AVE, BOISE, ID 83706-5387
(208) 695-3021
Mailing address
3248 S CADET AVE, BOISE, ID 83706-5387
(208) 695-3021
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/04/2020
Last updated
03/07/2023
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