Individual
REBECCA MICHELLE PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 E IDAHO ST STE 200, BOISE, ID 83712-6270
(208) 381-2711
(208) 381-4847
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1665
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/14/2019
Last updated
12/20/2023
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