Individual
MARINA J SAMPOGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10255 W OVERLAND RD, BOISE, ID 83709-1430
(208) 302-5600
(208) 302-5655
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5600
(208) 302-5655
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0110003294
VA
363AM0700X
Medical Physician Assistant
Primary
PA-1049
ID
363AM0700X
Medical Physician Assistant
—
VA
Other
Enumeration date
04/15/2010
Last updated
11/15/2016
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