Individual
SEAN P HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1210 NW 16TH ST, FRUITLAND, ID 83619-2202
(208) 452-8600
(208) 452-8601
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-204
ID
363AM0700X
Medical Physician Assistant
PA00575
OR
Other
Enumeration date
11/02/2005
Last updated
03/16/2011
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