Individual
EVAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1252 BENNETT AVE STE B, BURLEY, ID 83318-2664
(208) 647-0656
Mailing address
1252 BENNETT AVE STE B, BURLEY, ID 83318-2664
(208) 647-0656
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2622
ID
Other
Enumeration date
06/13/2022
Last updated
11/04/2023
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