ALYSSA MAY JACK

BLACKFOOT, ID
NPI1598357436
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1966)
Enumeration Date2021-02-10
Last Update Date2021-02-10
Business Address
ALYSSA MAY JACK PA-C
1350 PARKWAY DR STE 2
BLACKFOOT, ID 83221-1657
Phone number: 208-782-2410
Mailing Address
ALYSSA MAY JACK PA-C
4095 E MENAN LORENZO HWY
RIGBY, ID 83442-5169
Phone number: 208-847-5762
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