LACY ROSE WAGNER

BOISE, ID
NPI1508537507
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-2169)
Additional Taxonomies363A00000X Physician Assistant
Enumeration Date2021-09-21
Last Update Date2022-01-26
Business Address
LACY ROSE WAGNER PA
6051 W EMERALD ST
BOISE, ID 83704-8969
Phone number: 208-302-5150
Mailing Address
LACY ROSE WAGNER PA
3340 E GOLDSTONE DR
MERIDIAN, ID 83642-1026
Phone number: 208-302-9342