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1720356363
SOPHIA NYSWYN
MERIDIAN, ID
NPI
1720356363
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Former Name
ANNIE SOPHIA GLADSTON SOLOMON
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: ID PA941)
Enumeration Date
2011-12-10
Last Update Date
2011-12-10
Business Address
-- SOPHIA NYSWYN PA
520 S EAGLE RD STE 3112
MERIDIAN, ID 83642-6351
Phone number: 208-706-5800
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Mailing Address
-- SOPHIA NYSWYN PA
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2222
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