CHARISSE L MACK

BOISE, ID
NPI1801973615
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-632)
Additional Taxonomies363AS0400X Physician Assistant, Surgical
(Licence: ID  PA632)
Enumeration Date2006-11-01
Last Update Date2013-03-04
Business Address
-- CHARISSE L MACK PA
6140 CURTISIAN AVE STE 400
BOISE, ID 83704-8880
Phone number: 208-367-3500
Mailing Address
-- CHARISSE L MACK PA
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2222