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Individual

MARGO SMEDSHAMMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
3280 E LANARK DR, MERIDIAN, ID 83642-5982
(208) 377-4400
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA150530
OR
363A00000X
Physician Assistant
Primary
PA1572
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
213286
OR
05
808527800
ID
Enumeration date
08/11/2006
Last updated
06/24/2020
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