Individual
CAREY TANABE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
520 S EAGLE RD STE 3102, MERIDIAN, ID 83642-6352
(208) 706-5100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
363A00000X
Physician Assistant
Primary
PA-2342
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
05/29/2015
Last updated
12/01/2022
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