Individual
SUSAN E PAYTASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1673 W SHORELINE DR, SUITE 120, BOISE, ID 83702-6749
(208) 367-8383
(208) 429-8310
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA-596
ID
363AM0700X
Medical Physician Assistant
Primary
PA596
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807392700
—
ID
Enumeration date
11/28/2006
Last updated
02/20/2013
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