Individual
MOLLY C PICCONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6140 W CURTISIAN AVE, SUITE 100, BOISE, ID 83704-0109
(208) 367-7090
(208) 367-7092
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA-659
ID
363AS0400X
Surgical Physician Assistant
PA659
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8076996
—
ID
01
—
P00395077
RAILROAD MEDICARE
—
Enumeration date
02/21/2007
Last updated
12/05/2013
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